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Identifying Emergency Department Patients With Chest Pain Who Are at Low Risk for Acute Coronary Syndromes

July 2017

Inside This Issue

A missed diagnosis of acute coronary syndromes can be life threatening, but what about patients who appear to be at low risk of ACS? What are the best ways to make sure those at risk are flagged without ordering unnecessary testing? In this issue, you will learn to:

  • Order, manage, and evaluate ECG and biomarker testing, the first line of risk stratification
  • Identify the differences in the most-used clinical risk scores: TIMI, HEART, Vancouver, and EDACS
  • Assess the consensus guidelines on the value of confirmatory testing for low-risk patients
  • Discuss the latest evidence on high-sensitivity troponin testing and the accelerated diagnostic protocol
  • Manage the special diagnostic challenges with women, the young, the old, and those with previously treated CAD

Keywords: chest pain, angina, coronary artery disease, CAD, acute coronary syndrome, ACS, STEMI, NSTEMI, heart attack, myocardial infarction, MACE, major adverse cardiac event, ECG, EKG, electrocardiogram, risk stratification, clinical risk score, low risk, stress testing, TIMI, HEART, EDACS, NACPR, TRO CT, triple rule out, CCTA, coronary computed tomography angiography, biomarker, troponin 

Points

  • For the evaluation of suspected acute coronary syndromes (ACS) in the ED, consensus guidelines recommend obtaining basic history, physical examination, electrocardiogram (ECG), cardiac biomarkers, and chest radiography. If these tests are unremarkable, confirmatory tests can be performed, with a focus on diagnosis of atherosclerotic coronary artery disease (CAD).
  • History cannot reliably rule in or rule out ACS.

Pearl

  • The 2 most useful scores for the ED evaluation of undifferentiated chest pain for suspected ACS are the TIMI and HEART Scores.
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Last Modified: 07/23/2017
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