Galal Eldin Nagib-Elkilany
Tanta University, Egypt
Elkilany received his BSc  and MSc degrees  from Tanta University, Egypt and his PhD  & MD  from the Post-Graduate Institute of Cardiology Department, Tanta University School of Medicine, Egypt. He was a Research Fellow in Thorax Center, Rotterdam, Holland, Erasmus University in Stress Echocardiography Department on 2000/2001. He is a Cardiology Specialist and Faculty in Tanta University Hospital from 1991 until 1998. He also worked as Consultant Cardiologist -degree of Professor of Cardiology 1998-2015 [from the Supreme Council of Universities], Cairo, Egypt- law No. 115 (1993). He is a Clinical Fellow in Milano-Majore Policlinico, Milan, Italy 2007 in cardiac cath. He is a Lab and Partner clinical Fellowship and visitor physician at University of Alabama, Birmingham, USA in 2011. He received a price of Young Investigator Award from Egyptian Society of Cardiology on 1999 & 2001. He has many famous international publications to his credit.
Identification of high-risk patients in pre-symptomatic phase and low to intermediate risk patients suffering of acute chest pain has become the “holy grail” and efforts have evolved for risk profiling of such patients population. Cardiovascular laboratory care is an observation unit for the workup and management of patients with low to moderate risk chest pain suspicious for ischemic cardiac disease. This 6 bed unit lies within the medical department and functions 24 hours a day, 7 days a week. It is staffed by emergency physicians, nurses and midlevel providers with consultative services provided by cardiologist. Patients admitted to this unit generally are targeted for serial cardiac biomarkers, serial electrocardiograms (ECGs), observation and reexamination, echocardiography, deformation imaging and selective use of stress testing or other emerging imaging modalities (multi slice computed tomography and myocardial perfusion imaging). The average length of stay is 12 hours with 55 percent of patients discharged within the first 24 hours. The average annual census is greater than 1200 patients. Patients admitted to the chest pain unit are provided with all of the non-invasive diagnostic and management capabilities available to inpatients, but with much more definite highly specialized diagnostic testing. Such testing includes stress echocardiograms, exercise stress tests, strain and strain rate imaging, holter monitoring and coronary CTA as well. When nuclear stress testing or/and cardiac catheterization are required for the diagnosis of CAD; the patient is transferred directly to our tertiary hospital (50Km distance from our hospital). All patients admitted to the chest pain unit are evaluated by an emergency physician and midlevel provider. Serial cardiac biomarkers and electrocardiograms are part of a protocol of observation that often results in cardiology consultation. The CPU team tailors the need for further workup to the individual patient and follows up in cardiology out-patient clinic. Clinical research from Dibba Hospital –Fujairah Emirate has clearly demonstrated that establishment of a chest pain unit (CPU) improves the prognosis of patients with chest pain and myocardial infarction and also saves financial resources. Our initial experience in CPU showed that we can approximately save one billion Derhams (300Million USD) every year, if applied in all hospitals across the country. Consequently, it is important to introduce a Task Force to produce prerequisites for a CPU certification program to evaluate CPUs across the country. In the current study I will discuss the upcoming advancements in emerging imaging modalities recently applied for proper diagnosis of acute coronary syndromes and translation of these techniques into clinical practice.