title: Acute coronary syndromes in the emergency department: diagnostic characteristics, tests, and challenges.
abstract: Failure to diagnose patients who have acute coronary syndromes (ACSs)-either acute myocardial infarction (AMI) or unstable angina pectoris (UAP)-who present to the emergency department (ED) remains a serious public health issue. Better understanding of the pathophysiology of coronary artery disease has allowed the adoption of a unifying hypothesis for the cause of ACSs: the conversion of a stable atherosclerotic lesion to a plaque rupture with thrombosis. Thus, physicians have come to appreciate UAP and AMI as parts of a continuum of ACSs. This article reviews the state of the art regarding the diagnosis of ACSs in the emergency setting and suggests reasons why missed diagnosis continues to occur, albeit infrequently.
authors.affiliation: Baystate Medical Center, Springfield, MA 01199, USA. jameshpope@aol.com
authors.forename: J Hector
authors.initials: JH
authors.lastname: Pope
authors.forename: Harry P
authors.initials: HP
authors.lastname: Selker
mesh_terms: D000208:Acute Disease; D000789:Angina, Unstable / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D018570:Risk Assessment; D013577:Syndrome
chemical_list: D015415:Biomarkers