Acute Chest Pain in the Emergency Room

The Continuing Search to Identify the Very‐low‐risk Chest Pain Patient

“…We are very familiar with the potential benefits of emergency sonography and wrote one of the earliest articles on its use during ED resuscitations. 1 Yet we strongly disagree that the use of ultrasound, or the possession of an ED-based machine, is relevant to the questions of how well a program teaches essential procedures, or how autonomously a specific department of emergency medicine (EM) functions in a medical center. It is discouraging to us that so many EM faculty advisors stress asking about a technology whose role remains unclear and unproven.…”

“…Clinical studies confirmed our suspicions. 1 Although we could often easily identify the very-high-risk patient with acute myocardial infarction (AMI) on the basis of ST-segment elevations or hemodynamic compromise, it was more difficult to develop a strategy for safe and accurate identification of the very-low-risk patient. Consequently, we developed a liberal admission policy.…”

A Review of Atypical Clinical Manifestations of Acute Myocardial Infarction

“…In an attempt to identify patients at low risk of AMI, Lee and colleagues [2] found that a combination of clinical variables-one concerned with the patient's history, two with the quality of the chest pain-was preferable to any single variable indicators. However, the single best indicator of lowrisk patients was a normal ECG.…”

“…A better understanding of the early clues of AMI could result in faster recognition of myocardial pain by the victim. Earlier recognition by the victim could lead to less delay in seeking treatment, less myocardial ischemic damage, and, consequently, fewer deaths from coronary heart disease.In an attempt to reduce health care costs by decreasing the number of unnecessary admissions to coronary care units (CCUs) and identifying appropriate candidates for early discharge, efforts are being made to increase the reliability of diagnoses regarding myocardial pain [2][3][4]. Understanding the significance of chest pain is as difficult for the clinician as it is for the patient [5].…”

“…In an attempt to reduce health care costs by de-creasing the number of unnecessary admissions to coronary care units (CCUs) and identifying appropriate candidates for early discharge, efforts are being made to increase the reliability of diagnoses regarding myocardial pain [2][3][4]. Understanding the significance of chest pain is as difficult for the clinician as it is for the patient [5].…”