Diagnostic testing of the emergency department patient with chest pain.
In evaluating patients with nondiagnostic initial clinical or electrocardiogram (ECG) findings for acute cardiac ischemia, continuous 12-lead ECG monitoring increases the detection of diagnostic ECG findings, including ST-segment elevation, in patients awaiting hospital admission. Rest scanning with technitium-99m sestamibi is able to risk stratify low-moderate risk patients into lower and higher risk groups for cardiac events. Caveats include the reduced sensitivity of scanning of patients who are pain free and the need for follow-up exercise scans for patients free of perfusion defects at rest. Cardiac markers, particularly the troponins, show great promise for the detection of a larger part of the spectrum of acute coronary syndromes in the emergency department, including patients with minimal myocardial damage and higher risk for short-term death and nonfatal acute myocardial infarction. Accelerated diagnostic protocols using serial testing with cardiac markers, ECGs and then provocative testing over a 14-hour period, are feasible, safe, and cost-effective.
Zalenski
R J
RJ
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
Shamsa
F H
FH
D000208:Acute Disease; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood; D003935:Diagnostic Techniques, Cardiovascular; D004562:Electrocardiography; D004632:Emergency Medical Services; D006801:Humans; D007527:Isoenzymes; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications / Q000175:diagnosis; D009211:Myoglobin / Q000097:blood; D017256:Technetium Tc 99m Sestamibi
D007527:Isoenzymes; D009211:Myoglobin; D017256:Technetium Tc 99m Sestamibi; D003402:Creatine Kinase