title: The diagnosis of acute myocardial infarction in the emergency department; Part 1.
abstract: Despite major advances in treatment, the accurate diagnosis of acute myocardial infarction (AMI) in the emergency department (ED) remains a difficult clinical problem and is still mainly based on the history and interpretation of the electrocardiogram. Although the physician's clinical impression is a highly sensitive indicator for AMI, at least 4% of patients presenting to the ED with AMI may be mistakenly sent home. Although chest pain is the most common chief complaint, the clinical presentation can be extremely variable, particularly in the elderly. Complaints of sharp chest pain or chest wall tenderness should not be relied upon to exclude AMI. Radiation of chest pain is an important symptom. With careful analysis, the electrocardiogram may yield a higher diagnostic sensitivity than is commonly accepted.
authors.affiliation: Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.
authors.forename: C H
authors.initials: CH
authors.lastname: Herr
mesh_terms: D000368:Aged; D004562:Electrocardiography; D004630:Emergencies; D006801:Humans; D008487:Medical History Taking; D009203:Myocardial Infarction / Q000175:diagnosis*; D012307:Risk Factors; D012680:Sensitivity and Specificity