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Cardiac Testing

Cardiac Testing is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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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.
Pregnancy Considerations
In the pregnant patient with chest pain and ischemic changes on ECG, also consider spontaneous coronary artery dissection.

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Rosen, Peter, et al., editors. "Cardiac Testing." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307166/all/Cardiac_Testing.
Cardiac Testing. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307166/all/Cardiac_Testing. Accessed April 26, 2019.
Cardiac Testing. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307166/all/Cardiac_Testing
Cardiac Testing [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307166/all/Cardiac_Testing.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Cardiac Testing ID - 307166 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307166/all/Cardiac_Testing PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -