1. “My patient was young and healthy, so I didn’t suspect ACS.”
Younger patients are at lower risk of ACS, but 4% to 8% of myocardial infarctions still occur in patients < 40 years old. While traditional cardiac risk factors are generally not useful in the management of undifferentiated chest pain, a high risk-factor burden is more predictive of ACS in younger patients. Validated clinical risk scores can identify very-low-risk patients in this age group with excellent accuracy.
2. “Her symptoms didn’t sound like angina, so ACS wasn’t even in my differential diagnosis.”
A patient's history cannot reliably exclude ACS. Atypical symptoms are often present and are more common in women, the elderly, and diabetics. Additional testing, especially in these population groups, should be considered to reliably rule out ACS.
3. “The pain was reproducible on palpation, so I ruled out ACS.”
Pain that is reproducible on palpation lowers the risk of ACS, but does not exclude it.
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