Exercise testing in chest pain units: rationale, implementation, and results.
Chest pain units are now established centers for assessment of low-risk patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome. Accelerated diagnostic protocols, of which treadmill testing is a key component, have been developed within these units for efficient evaluation of these patients. Studies of the last decade have established the utility of early exercise testing,which has been safe, accurate, and cost-effective in this setting. Specific diagnostic protocols vary, but most require 6 to 12 hours of observation by serial electrocardiography and cardiac injury markers to exclude infarction and high-risk unstable angina before proceeding to exercise testing. However, in the chest pain unit at UC Davis Medical Center,the approach includes "immediate" treadmill testing without a traditional process to rule out myocardial infarction. Extensive experience has validated this approach in a large, heterogeneous population. The optimal strategy for evaluating low-risk patients presenting to the emergency department with chest pain will continue to evolve based on current research and the development of new methods.
Amsterdam
Ezra A
EA
Department of Internal Medicine, University of California School of Medicine (Davis) and Medical Center, Sacramento, CA 95817, USA. eaamsterdam@ucdavis.edu
Kirk
J Douglas
JD
Diercks
Deborah B
DB
Lewis
William R
WR
Turnipseed
Samuel D
SD
D000208:Acute Disease; D000789:Angina, Unstable / Q000175:diagnosis*; D003325:Coronary Care Units; D042241:Early Diagnosis; D005080:Exercise Test; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis*; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D013577:Syndrome