title: The Interdisciplinary Management of Acute Chest Pain.
abstract: BACKGROUND
  Acute chest pain of non-traumatic origin is a common reason for presentation to physician's offices and emergency rooms. Coronary heart disease is the cause in up to 25% of cases. Because acute chest pain, depending on its etiology, may be associated with a high risk of death, rapid, goal-oriented management is mandatory.
  
  
  METHODS
  This review is based on pertinent articles and guidelines retrieved by a selective search in PubMed.
  
  
  RESULTS
  History-taking, physical examination, and a 12-lead electrocardiogram (ECG) are the first steps in the differential diagnostic process and generally allow the identification of features signifying a high risk of lifethreatening illness. If the ECG reveals ST-segment elevation, cardiac catheterization is indicated. The timedependent measurement of highly sensitive troponin values is a reliable test for the diagnosis or exclusion of acute myocardial infarction. A wide variety of other potential causes (e.g., vascular, musculoskeletal, gastroenterologic, or psychosomatic) must be identified from the history if they are to be treated appropriately. Elderly patients need special attention.
  
  
  CONCLUSIONS
  Acute chest pain is a major diagnostic challenge for the physician. Common errors are traceable to non-recognition of important causes and to an inadequate diagnostic work-up. Future studies should be designed to help optimize the interdisciplinary management of patients with chest pain.
authors.affiliation: Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuernberg, Department of General Practice/Family Medicine, University of Marburg, Department of Psychosomatics and Psychotherapeutic Medicine, Paracelsus Medical University, Nuernberg, Department of Gastroenterology, Hepatology, Neurogastroenterology, Infectiology, Hematology and Oncology, HELIOS Hospital Krefeld, Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Raphael R
authors.initials: RR
authors.lastname: Bruno
authors.forename: Norbert
authors.initials: N
authors.lastname: Donner-Banzhoff
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Söllner
authors.forename: Thomas
authors.initials: T
authors.lastname: Frieling
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.forename: Michael
authors.initials: M
authors.lastname: Christ
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003422:Critical Care / Q000379:methods*; D019033:Delivery of Health Care, Integrated; D004562:Electrocardiography / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D008487:Medical History Taking / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration; D013896:Thoracic Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I