When to Rule Out ACS: 3 Simple Recommendations

Amal Mattu, MD


July 05, 2012

In This Article

3 Simple Recommendations

On the basis of my interpretation of these important studies, I have 3 simple recommendations:

  1. If you are worried about a patient, don't use these studies to obviate your concern. Remember that even though there are factors that decrease the likelihood of ACS, none of them risk-stratify a patient to "no risk."

  2. However, if you are planning on sending a patient with chest pain home, make sure you document as many of those low-risk features as possible. Documentation of low-risk features will significantly increase the defensibility of your chart if there is an adverse outcome.

  3. The most important clinical predictors of ACS and acute MI seem to be the following: chest pain that radiates (especially bilaterally or to the right side), associated diaphoresis, associated vomiting, and pain on exertion. Assess every one of your patients with chest pain for these 4 historical features, and if the answer to any of these is "yes," seriously think twice about sending that patient home.

These 3 publications and 3 suggestions will hopefully decrease patient and provider risk and add a bit more clarity to an often murky evaluation process.



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