Management Strategies for Patients with Low-Risk Chest Pain in the Emergency Department |
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Authors: | Maame Yaa A. B. Yiadom Joshua M. Kosowsky |
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Affiliation: | Department of Emergency Medicine, Brigham and Women's Hospital, 10 Vining Street, Neville House, Boston, MA, 02115, USA, myiadom@gmail.com. |
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Abstract: | There is abundant evidence to guide the management of chest pain patients with a confirmed or reasonably suspected diagnosis of acute coronary syndrome (ACS). But when it comes to the low-risk chest pain patient in the emergency department, there is limited evidence to support one approach over another. As a result, the evaluation of low-risk chest pain represents a distinct challenge for the emergency physician. Missing a diagnosis of ACS is certainly undesirable. However, the overuse of technology can result in misleading test results in populations with a low incidence of coronary disease. In this article, we dispel several myths surrounding low-risk chest pain and put forward a number of common-sense recommendations. We endorse taking a focused but thorough chest pain history; encourage the use of serial electrocardiogram, particularly for patients with ongoing or changing symptoms; comment on the interpretation of cardiac biomarkers in the era of highly sensitive troponin assays, drawing a distinction between myocardial injury and myocardial infarction; discuss the role of coronary computed tomography angiography as a test for coronary artery disease, rather than for ACS; and caution against the reflexive use of provocative testing in low-risk chest pain patients. |
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