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Emergency Department Presentation

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Short Stay Management of Chest Pain

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Patients with acute coronary syndrome (ACS) may present to the emergency department (ED) via emergency medical services or self-transport. When they present via emergency medical services, a diagnostic-quality prehospital 12-lead EKG may enhance the sensitivity and specificity of ACS diagnosis and shorten time to treatment. The ED evaluation of the patient at risk for ACS includes a thorough history and physical assessment of major risk factors for coronary artery disease (diabetes mellitus, hyperlipidemia, hypertension, family history, smoking history), timely and repeated 12-lead EKG, and cardiac biomarkers (preferably point-of-care testing). When evaluating a patient for ACS, the emergency physician must be conscientious of the prevalence of atypical ACS symptoms such as dyspnea, nausea, diaphoresis syncope or pain in the arms, epigastrium, shoulder, or neck. These atypical presentations are most notably studied in the patients of older age, with diabetes mellitus, of female gender, and of nonwhite race. In addition to assessing for the presence of ACS, other life-threatening conditions must also be considered, the most important being aortic dissection, pulmonary embolism, pericarditis with pericardial tamponade, esophageal perforation (Boerhaave’s syndrome), and spontaneous pneumothorax.

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Authors and Affiliations

  1. Department of Emergency Medicine, Maine Medical Center, Portland, OH 45267, USA

    Sean Collins MD, FACEP

  2. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA

    Jeffrey A. Holmes

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  1. Jeffrey A. Holmes
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  2. Sean Collins MD, FACEP
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Correspondence to Jeffrey A. Holmes .

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    © 2009 Humana Press, a part of Springer Science+Business Media, LLC

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    Holmes, J.A., Collins, S. (2009). Emergency Department Presentation. In: Cannon, C., Peacock, W. (eds) Short Stay Management of Chest Pain. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-60327-948-2_5

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    • DOI: https://doi.org/10.1007/978-1-60327-948-2_5

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