Parâmetros avaliados na triagem da dor torácica em um serviço de urgência hospitalar

• Ano de defesa: 2015
• Autor(a) principal: Simone Martins Gonçalves
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Marcadores cardíacos; Síndrome coronariana aguda; Dor torácica; Marcadores biológicos; Coração Doenças; Infarto do miocárdio
• Link de acesso: http://hdl.handle.net/1843/BUOS-AN9RDF

Cardiovascular diseases (CVD) became a major public health problem, with multifactorial causes which are divided into modifiable and non-modifiable. Acute Coronary Syndrome (ACS) is the most common manifestation corresponding to signs and symptoms that occur with ischemia and outcome of angina or acute myocardial infarction (AMI) among all others CVD. Above all, the evaluation of chest pain remains a major challenge at emergency services. Indeed, analysis of blood markers presents an important tool for the diagnosis of AMI, alternatively other clinical conditions, non-SCA, may lead to changes into electrocardiogram (ECG) ST segment. 1380 medical records of adult patients were evaluated, classified by application of chest pain by using Manchester Protocols. This paper aims to investigate clinical markers, biochimestry and hemostatic qualified to protocol for patients with chest pain at the emergency service, and their association with Acute Coronary Syndrome, by focusing the AMI. Among the patients facing cardiarc arrest there were a significant and more frequent seeking for the emergency services at the first 12 hours after pain chest onset (p=0.011), and 42% of this group seek for help with more than 13hours from the beginning of the chest pain. The markers in serial analyses, myoglobin (p<0.001), CK-MB mass (p<0.001) and cardiac troponin I (p<0.001) and studied population characteristics as average 66.2 ± 13.2 years, male, with high blood pressure (p<0.001), myocardial report on the previous event (p<0.026) and electrocardiogram examination (p<0.001) showed consistent results with previous reports in the literature for infarction patients. By statistical analysis of individual independence a significant relationship between D-dimer markers (p<0.001) and natriuretic peptide type B (p<0.001) with AMI was presented. There was a compatibility between D-dimer and BNP ratio affected to the infarcted ones. High levels of D-dimer were also correlated with the use of anticoagulant and platelet antiaggregant drugs in order to evaluate D-dimer as a promising marker for CVD failure prevention therapy. The decisive statistical model has shown that the following variables were predictors to AMI as the ECG examination on admission at the emergency services, previous AMI historic, myoglobin in the third hour and cardiac troponin I in the sixth hour after admission, with a significant level of 0.05. ECG, Mgb (3H) and TNI (6H) examinations as well as patients cardiac history are variations which allow predicting, in an efficient manner, that AMI in the studied population indicate this work importance to elaborate the risk scores. It is advisable that myoglobin marker be kept on the laboratory analyses by considered that the studied work is related to cardiac disease and may refer to previous condition of recent cardiac arrest, this event on other sorting markers with a higher sensibility to AMI, like troponin, may be still affected. It became evident that a high vulnerability towards the studied population who suffered from cardiac arrest is being the great challenge by the time from the begin of chest pain and emergency services admission, therapeutic failure in patients who take platelet antiaggregant drugs as well as troponin tests that contribute to a faster diagnostic at point-care of patients with this potentially fatal disease. An interpretative analysis of the obtained data do not prioritize the inclusion non-troponin markers on the routine for seeing patients with chest pain once the acquired value to sensibility, specificity and positive predictive value (PPV) that were not acceptable to confirm AMI in addition to add a greater cost. From the begin of the chest pain to emergency services admission there is still a challenge and, to a better understanding of the risk factors associated to the studied population, the clinical patient registrations at medical records need improvement to a greater information safety.