Early diagnosis of acute coronary syndrome.

The diagnostic evaluation of acute chest pain has been augmented in recent years by advances in the sensitivity and precision of cardiac troponin assays, new biomarkers, improvements in imaging modalities, and release of new clinical decision algorithms. This progress has enabled physicians to diagnose or rule-out acute myocardial infarction earlier after the initial patient presentation, usually in emergency department settings, which may facilitate prompt initiation of evidence-based treatments, investigation of alternative diagnoses for chest pain, or discharge, and permit better utilization of healthcare resources. A non-trivial proportion of patients fall in an indeterminate category according to rule-out algorithms, and minimal evidence-based guidance exists for the optimal evaluation, monitoring, and treatment of these patients.

Diagnosis and treatment of depression in patients with congestive heart failure: a review of the literature.

Context: Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure.

Objective: We sought to review the prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure.

The meaningful use of the review of symptoms in heart failure patients.

Review of symptoms (ROS) is a time-honored tradition in medicine and has proved to be a case-finding maneuver in general medicine patients. The authors sought to investigate the prevalence of noncardiovascular symptoms in heart failure clinics by assessment of the ROS. Of the collected ROS, shortness of breath (SOB) represented the most frequent recalled symptom (8.

Mortality benefit of a comprehensive heart failure disease management program in indigent patients.

Background: Heart failure (HF) produces significant morbidity and mortality. Although HF disease management (HFDM) programs have been shown to decrease this morbidity, there is still a paucity of data on their effect on mortality. The objective of this study was to determine whether participation in an HFDM program would reduce mortality in an indigent population from rural Louisiana.