Description

• Cardiac testing is indicated for emergency department 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 myocardial infarction (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, labs, and ECG are critical elements in working up chest pain and ACS/HF
  • History, physical, labs, and ECG nevertheless miss 1–4% of all heart attacks
  • Various imaging modalities are also commonly used and helpful in patients with chest pain

Etiology

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