Acute Evaluation of Chest Pain

Abstract

Of the approximately 130 million emergency department visits annually, many will be due to a cardiovascular cause (https://www.cdc.gov/nchs/fastats/emergency-department.htm). Cardiovascular complaints also frequently require hospital admission. Congestive heart failure is the second leading cause of emergency department (ED) visit requiring hospital admission, comprising 4.1% of all hospital admissions (https://www.hcup-us.ahrq.gov/reports/statbriefs/sb277-Top-Reasons-Hospital-Stays-2018.pdf#:~:text=%E2%96%A0%20The%20most%20frequent%20principal%20diagnoses%20for%20hospitalizations,stays%29%20and%20the%20costliest%20%28%2441.5%20billion%20in%20aggregate%29). Acute myocardial infarction (AMI) and cardiac dysrhythmias are also among the top 10 admission diagnoses with 2.5% and 2.2% of all hospital admissions, respectively (https://www.hcup-us.ahrq.gov/reports/statbriefs/sb277-Top-Reasons-Hospital-Stays-2018.pdf#:~:text=%E2%96%A0%20The%20most%20frequent%20principal%20diagnoses%20for%20hospitalizations,stays%29%20and%20the%20costliest%20%28%2441.5%20billion%20in%20aggregate%29). Cardiac disease remains the leading cause of death in the United States, accounting for 211.5 deaths per 100,000. Patient presentations will include a wide array of disease severity and urgency to establish a diagnosis. Exclusion of life-threatening diagnoses should be performed via a rapid and thorough manner prior to the consideration of more benign etiologies. In this chapter, we will discuss the initial approach to patients complaining of chest pain. Focus on pertinent elements of patient history, physical examination, laboratory, and imaging findings should guide rapid diagnosis and treatment.