Does the patient with chest pain have ACS?
The Rational Clinical Examination Systematic Review. Importance About 10% of patients with acute chest pain are ultimately diagnosed with acute coronary syndrome (ACS).
What is a chest pain rule out?
Determining whether chest pain is anginal, atypical anginal, or nonanginal is recommended to help determine a patient’s cardiac risk. The Rouan decision rule is recommended to help predict which patients are at higher risk of MI. A Wells score of less than 2 plus a normal d-dimer assay should rule out PE.
What can mimic ACS?
Conditions that mimic acute coronary syndrome (ACS) include cocaine-induced chest pain, pericarditis, myocarditis, coronary artery dissection, and Takotsubo cardiomyopathy.
When should you suspect ACS?
When to see a doctor Acute coronary syndrome is a medical emergency. Chest pain or discomfort can be a sign of any number of life-threatening conditions. Get emergency help for a prompt diagnosis and appropriate care. Do not drive yourself to the hospital.
How can you detect chest pain?
Symptoms
- Pressure, fullness, burning or tightness in your chest.
- Crushing or searing pain that spreads to your back, neck, jaw, shoulders, and one or both arms.
- Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or varies in intensity.
- Shortness of breath.
- Cold sweats.
When should you refer to chest pain?
Referral criteria Patients with exertional chest pain suggestive of new onset angina within the last two months. Pain that is suggestive of cardiac ischaemia and / or has some atypical features but is accompanied by significant cardiac risk.
Can blood test detect myocardial infarction?
Tests available include: Cardiac Troponin I or Troponin T – which are both very sensitive and specific and are the recommended laboratory tests for the diagnosis of MI. Serial testing is recommended in order to confirm or exclude a rise or fall in troponin concentration.
Which symptom is considered a typical symptom indicative of ACS?
Chest pain or discomfort is the most common symptom.
What finding is considered high risk when evaluating a patient for ACS?
Physical examination findings that indicate a large area of ischemia and high risk include diaphoresis; pale, cool skin; sinus tachycardia; a third or fourth heart sound; basilar rales; and hypotension. The physical examination may also provide clues that can help in determining the differential diagnosis.
What kind of chest pain is low risk for ACS?
A meta-analysis of studies that evaluated the role of previous chest pain in diagnosing ACS concluded that chest pain that is pleuritic, positional, or reproducible with palpation and not related to exertion is low risk for ACS.
How to diagnose acute chest pain in adults?
Those at low or intermediate risk of ACS can undergo exercise stress testing, coronary computed tomography angiography, or cardiac magnetic resonance imaging. In those with low suspicion for ACS, consider other diagnoses such as chest wall pain or costochondritis, gastroesophageal reflux disease, and panic disorder or anxiety states.
How to diagnose acute coronary syndrome ( ACS )?
New transient mitral regurgitation, hypotension, diaphoresis, pulmonary edema or rales New or presumably new transient ST-segment deviation (> 0.05 mV) or T-wave inversion (> 0.2 mV) with symptoms ACS = acute coronary syndrome; ECG = electrocardiogram; CK-MB = MB isoenzyme of creatine kinase.
Is it normal to have sharp chest pain?
The same study 5 demonstrated that patients presenting with sharp or stabbing pain, pleuritic pain, and positional chest pain had only a 3 percent likelihood of having acute coronary syndrome. The physical examination in patients with acute coronary syndrome frequently is normal.