How should chest pain be assessed in suspected acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Increasing public awareness of the typical and atypical presentations of ACS is of the utmost importance for optimal and timely treatment. Many patients do not recognize that their symptoms are cardiac in origin and therefore may delay seeking medical help. Patients with established CAD call emergency medical services if they have chest pain that does not resolve after they take a sublingual nitroglycerin tablet.

In patients presenting to the ED with chest pain, a structured diagnostic approach that includes time-focused ED decision points, brief observation, and selective application of early outpatient provocative testing appeared both safe and diagnostically efficient in a study by Scheuermeyer et al. However, some patients with ACS may be discharged for outpatient stress testing on the index ED visit. [16]


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