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- Cardiac testing is indicated for emergency patients at risk for heart failure (HF) or acute coronary syndrome (ACS).
- These pathologies may be thought of as a spectrum: Unstable angina can evolve into MI, which in turn can cause HF:
- ∼20% of ED malpractice claims are due to missed diagnosis of ACS.
- ∼2% of patients with ACS are inappropriately discharged from an ED.
- History, physical exam, and ECG are the critical elements in working up chest pain and ACS/HF.
- History, physical, and ECG nevertheless miss 1–4% of all heart attacks.
- Additional tools include imaging modalities and blood tests (e.g., cardiac biomarkers).
ACS is caused by atherosclerotic narrowing of coronary vessels or by coronary vasospasm.
In the pregnant patient with chest pain and ischemic changes on ECG, also consider spontaneous coronary artery dissection.