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HERO ID
7301983
Reference Type
Journal Article
Title
Acute Chest Pain in Adults: Outpatient Evaluation
Author(s)
Mcconaghy, , JR; Sharma, M; Patel, H
Year
2020
Is Peer Reviewed?
Yes
Journal
American Family Physician
ISSN:
0002-838X
EISSN:
1532-0650
Volume
102
Issue
12
Page Numbers
721-727
Language
English
PMID
33320506
Web of Science Id
WOS:000604409800002
Abstract
Approximately 1% of primary care office visits are for chest pain, and 2% to 4% of these patients will have unstable angina or myocardial infarction. Initial evaluation is based on determining whether the patient needs to be referred to a higher level of care to rule out acute coronary syndrome (ACS). A combination of age, sex, and type of chest pain can predict the likelihood of coronary artery disease as the cause of chest pain. The Marburg Heart Score and the INTERCHEST clinical decision rule can also help estimate ACS risk. Twelve-lead electrocardiography is recommended to look for ST segment changes, new-onset left bundle branch block, presence of Q waves, and new T-wave inversions. Patients with suspicion of ACS or changes on electrocardiography should be transported immediately to the emergency department. Those at low or intermediate risk of ACS can undergo exercise stress testing, coronary computed tomography angiography, or cardiac magnetic resonance imaging. In those with low suspicion for ACS, consider other diagnoses such as chest wall pain or costochondritis, gastroesophageal reflux disease, and panic disorder or anxiety states. Other less common, but important, diagnostic considerations include acute pericarditis, pneumonia, heart failure, pulmonary embolism, and acute thoracic aortic dissection.
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