Chest Pain Units: A Modern Way of Managing Patients with Chest Pain in the Emergency Department

Abstract

It is estimated that 5 to 8 million individuals with chest pain or other symptoms suggestive of myocardial ischemia are seen each year in emergency departments (ED) in the United States 1,2, which corresponds to 5 to 10% of all visits 3,4. Most of these patients are hospitalized for evaluation of possible acute coronary syndrome (ACS). This generates an estimated cost of 3 - 6 thousand dollars per patient 5,6. From this evaluation process, about 1.2 million patients receive the diagnosis of acute myocardial infarction (AMI), and just about the same number have unstable angina. Therefore, about one half to two thirds of these patients with chest pain do not have a cardiac cause for their symptoms 2,3. Thus, the emergency physician is faced with the difficult challenge of identifying those with ACS - a life-threatening disease - to treat them properly, and to discharge the others to suitable outpatient investigation and management.

Sudden onset of chest pain associated with PR-segment depression in ECG

“…Most of these patients are hospitalized because of uncertainty of the cause of their symptom. 1 The evaluation of patients presenting to the emergency department with chest pain remains a continuing challenge.…”

Chest Pain Centers

“…Consequently, several specialty medical societies in countries around the world have worked to provide an organized approach to evaluate and manage the patient with ACS symptoms. 2,[24][25][26][27][28] Specific institutions in China, Saudi Arabia, the United Arab Emirates, and Germany have achieved accreditation as CPCs by the SCPC (http://www.scpcp.org/newmap/newmap.php). Though local processes vary somewhat between these countries, institutions in each were able to show they met compliance with accreditation standards set by the SCPC.…”

Comparing the risk factors of coronary artery diseases in patients with stenotic and ectatic lesions

“…6 Of 5.3 million patients which yearly referred to emergency with chest pain in America about third hospitalized by UA or USTEMI diagnosis that is the prevalent reason for hospitalization. 7,8 Also in Iran heart diseases are the prevalent causes of deaths and about 46% of deaths due to heart diseases. 9 Yearly about 3 million people only hospitalized in hospitals of ministry health and most of them have acute coronary syndrome (ACS).…”

“…10 ACS includes myocardial infarction with elevated ST segment (STEMI), myocardial infarction without elevated ST segment and unstable angina. 7,8 Acute myocardial infarction is one of the most diagnoses in hospitalized patients in developed countries hospitals which annually about 650000 AMI new cases occur in USA. Although the rate of AMI is about 30% that more than half of them occur before patient reach to hospital.…”