Doctor, I feel pain in my chest

Shakeel Kautbally, François Simon, Alisson Slimani, Christophe Beauloye Published in the journal : October 2018 Category : Examens cliniques

In general practice, chest pain is a very common clinical complaint. The general practitioner’s decision to refer a patient to hospital is mainly based on chest pain characterization, patient's cardiovascular history, as well as electrocardiographic and hemodynamic changes. Acute coronary syndrome (ACS) remains the main diagnostic challenge. In this case, a coronary angiography must generally be performed, but the delay will depend on the type of ACS. ST-segment elevation myocardial infarction (STEMI) requires rapid transport to the emergency room, given that the time to reperfusion (time span from diagnosis to coronary reperfusion, ideally <60 min) determines the patient’s prognosis. Patients with non-ST segment infarction (NSTE-ACS) should undergo angiography within 24 to 72 hours. Platelet inhibitors (aspirin and P2Y12 receptor inhibitors) are the cornerstone of pharmacological treatment. They are generally administered over 1 year. Beyond initial diagnosis, the general practitioner also plays a crucial role in ensuring continuity of care following hospitalization, since these patients are at high risk of relapse.

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Doctor, my head is spinning…

Naïma Deggouj(1), Daniel Moens(2), Daniele De Siati(1) Published in the journal : October 2018 Category : Examens cliniques

When contacted by a patient suffering from acute vertigo or dizziness, the general practitioner needs easy clinical tools enabling him to screen for urgent and life-threatening central vestibular disorders in a timely and reliable manner. Some subjective complaints are red flags that indicate the need for a rapid medical examination before a possible referral to a neurology emergency unit. Using the HINTS tool must be further promoted, given that it proved to be specific and sensitive in detecting central vestibular disorders. After a review of the subjective symptoms and clinical signs that evoke central vestibular disorders, the article presents the most frequent peripheral vestibular disorders.

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