Low Risk Chest Pain

CP Differentials...that will kill you

• PE
• Esophageal Rupture
• Tension Pneumothoarax
• MI
• Aortic Dissection
• Cardiac Tamponade

Introduction

• Of those with CP 7% will have EKG changes and 6-10% will have troponin changes. 5-15% have ACS.
• Low risk = patients who have "chest pain" or ischemic symptoms but no evidence of ACI or infarction— no characteristic ECG changes and normal levels of cardiac markers
• only 4% discharged!

CP features

• Lowest: include pleuritic, positional, reproducible, sharp/stabbing pain, pain that is not exertional.
• Higher: radiation to RIGHT arm/shoulder > BOTH arms/shoulders >> LEFT arm
• 18% to 45% of ACS patients have relief of pain with antacids...

Untitled Slide

• EKG
• Recent cardiac cath reports are useful because a truly negative result is associated with a very low incidence of subsequent infarction or ACS in the next 2 years.
• Recent negative evaluation for ACS that included stress testing have a 6-month incidence of ACS as high as 14%...

Dispo

• Admit vs D/C
• Decision Tools

HEART Score

• The study was created in the Netherlands, validated by Wake Forest University, and subsequently prospectively validated in the Netherlands again
• Composed of 5 components: history, ECG, age, risk factors, and a single current generation troponin at arrival.