title: [Chest pain units. Organization and protocol for the diagnosis of acute coronary syndromes].
abstract: The two main goals of chest pain units are the early, accurate diagnosis of acute coronary syndromes and the rapid, efficient recognition of low-risk patients who do not need hospital admission. Many clinical, practical, and economic reasons support the establishment of such units. Patients with chest pain account for a substantial proportion of emergency room turnover and their care is still far from optimal: 8% of patients sent home are later diagnosed of acute coronary syndrome and 60% of admissions for chest pain eventually prove to have been unnecessary.We present a systematic approach to create and manage a chest pain unit employing specialists headed by a cardiologist. The unit may be functional or located in a separate area of the emergency room. Initial triage is based on the clinical characteristics, the ECG and biomarkers of myocardial infarct. Risk stratification in the second phase selects patients to be admitted to the chest pain unit for 6-12 h. Finally, we propose treadmill testing before discharge to rule out the presence of acute myocardial ischemia or damage in patients with negative biomarkers and non-diagnostic serial ECGs.
authors.affiliation: Servicio de Cardiologia, Hospital de Leon, Avda, Spain.
authors.forename: Julián
authors.initials: J
authors.lastname: Bayón Fernández
authors.forename: Eduardo
authors.initials: E
authors.lastname: Alegría Ezquerra
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch Genover
authors.forename: Adolfo
authors.initials: A
authors.lastname: Cabadés O'Callaghan
authors.forename: Ignacio
authors.initials: I
authors.lastname: Iglesias Gárriz
authors.forename: José Julio
authors.initials: JJ
authors.lastname: Jiménez Nácher
authors.forename: Félix
authors.initials: F
authors.lastname: Malpartida De Torres
authors.forename: Ginés
authors.initials: G
authors.lastname: Sanz Romero
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D002985:Clinical Protocols; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005080:Exercise Test; D006801:Humans; D017202:Myocardial Ischemia; D018710:Pain Clinics / Q000458:organization & administration*; D013577:Syndrome
chemical_list: D015415:Biomarkers