Cardiac Emergencies: Acute Chest Pain

  • Florian Schwarz
Part of the Medical Radiology book series (MEDRAD)


Acute chest pain is one of the most common complaints in patients presenting to the emergency department (ED). In a survey of emergency room utilization in the United States in 2011, chest pain accounted for 5.2 % of all visits and was thus second only to abdominal pain as the most common presenting complaint (Anon 2014). In male patients age 65 or older, chest pain is the most common complaint accounting for 9.0 % of all visits.


Acute Coronary Syndrome Coronary Plaque Acute Coronary Syndrome Patient Acute Chest Pain Test Bolus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Anon (2014) National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2011 emergency department summary tablesGoogle Scholar
  2. Antman EM et al (2000) The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 284(7):835–842CrossRefPubMedGoogle Scholar
  3. Chang AM et al (2011) Does coronary artery calcium scoring add to the predictive value of coronary computed tomography angiography for adverse cardiovascular events in low-risk chest pain patients? Acad Emerg Med Off J Soc Acad Emerg Med 18(10):1065–1071CrossRefGoogle Scholar
  4. Cury RC, Budoff M, Taylor AJ (2013) Coronary CT angiography versus standard of care for assessment of chest pain in the emergency department. J Cardiovasc Comput Tomogr 7(2):79–82CrossRefPubMedGoogle Scholar
  5. Deseive S et al (2015) Image quality and radiation dose of a prospectively electrocardiography-triggered high-pitch data acquisition strategy for coronary CT angiography: the multicenter, randomized PROTECTION IV study. J Cardiovasc Comput Tomogr 9(4):278–285CrossRefPubMedGoogle Scholar
  6. Ferencik M et al (2012) A computed tomography-based coronary lesion score to predict acute coronary syndrome among patients with acute chest pain and significant coronary stenosis on coronary computed tomographic angiogram. Am J Cardiol 110(2):183–189CrossRefPubMedPubMedCentralGoogle Scholar
  7. Fox KAA et al (2006) Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ (Clin Res Ed) 333(7578):1091CrossRefGoogle Scholar
  8. Galperin-Aizenberg M et al (2015) Cardiac CT angiography in the emergency department. AJR Am J Roentgenol 204(3):463–474CrossRefPubMedGoogle Scholar
  9. Georgiou D et al (2001) Screening patients with chest pain in the emergency department using electron beam tomography: a follow-up study. J Am Coll Cardiol 38(1):105–110CrossRefPubMedGoogle Scholar
  10. Giroud D et al (1992) Relation of the site of acute myocardial infarction to the most severe coronary arterial stenosis at prior angiography. Am J Cardiol 69(8):729–732CrossRefPubMedGoogle Scholar
  11. Goldstein JA et al (2007) A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol 49(8):863–871CrossRefPubMedGoogle Scholar
  12. Goldstein JA et al (2011) The CT-STAT (coronary computed tomographic angiography for systematic triage of acute chest pain patients to treatment) trial. J Am Coll Cardiol 58(14):1414–1422CrossRefPubMedGoogle Scholar
  13. Hoffmann U et al (2009) Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol 53(18):1642–1650CrossRefPubMedPubMedCentralGoogle Scholar
  14. Hoffmann U et al (2012) Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med 367(4):299–308CrossRefPubMedPubMedCentralGoogle Scholar
  15. Hollander JE et al (2009) One-year outcomes following coronary computerized tomographic angiography for evaluation of emergency department patients with potential acute coronary syndrome. Acad Emerg Med Off J Soc Acad Emerg Med 16(8):693–698CrossRefGoogle Scholar
  16. Hollander JE et al (2016) Coronary computed tomography angiography versus traditional care: comparison of one-year outcomes and resource use. Ann Emerg Med 67(4):460–468.e1CrossRefPubMedGoogle Scholar
  17. Hulten E et al (2013) Outcomes after coronary computed tomography angiography in the emergency department: a systematic review and meta-analysis of randomized, controlled trials. J Am Coll Cardiol 61(8):880–892CrossRefPubMedGoogle Scholar
  18. Kitagawa T et al (2009) Characterization of noncalcified coronary plaques and identification of culprit lesions in patients with acute coronary syndrome by 64-slice computed tomography. JACC Cardiovasc Imaging 2(2):153–160CrossRefPubMedGoogle Scholar
  19. Laudon DA et al (1999) Use of electron-beam computed tomography in the evaluation of chest pain patients in the emergency department. Ann Emerg Med 33(1):15–21CrossRefPubMedGoogle Scholar
  20. Litt HI et al (2012) CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med 366(15):1393–1403CrossRefPubMedGoogle Scholar
  21. Maurovich-Horvat P et al (2012) The napkin-ring sign indicates advanced atherosclerotic lesions in coronary CT angiography. JACC Cardiovasc Imaging 5(12):1243–1252CrossRefPubMedGoogle Scholar
  22. Maurovich-Horvat P et al (2010) The napkin-ring sign: CT signature of high-risk coronary plaques? JACC Cardiovasc Imaging 3(4):440–444CrossRefPubMedGoogle Scholar
  23. McLaughlin VV, Balogh T, Rich S (1999) Utility of electron beam computed tomography to stratify patients presenting to the emergency room with chest pain. Am J Cardiol 84(3):327–328, A8CrossRefPubMedGoogle Scholar
  24. Miller CD et al (2012) Implications of 25% to 50% coronary stenosis with cardiac computed tomographic angiography in ED patients. Am J Emerg Med 30(4):597–605CrossRefPubMedGoogle Scholar
  25. Puchner SB et al (2014) High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 64(7):684–692CrossRefPubMedPubMedCentralGoogle Scholar
  26. Roe MT et al (2000) Clinical and therapeutic profile of patients presenting with acute coronary syndromes who do not have significant coronary artery disease. The Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial. Circulation 102(10):1101–1106CrossRefPubMedGoogle Scholar
  27. Roffi M et al. (2015) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 37(3):ehv320Google Scholar
  28. Rybicki FJ et al (2016) 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Comm. J Am Coll Cardiol 67(7):853–879CrossRefPubMedGoogle Scholar
  29. Schenker MP et al (2008) Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: a combined positron emission tomography/computed tomography study. Circulation 117(13):1693–1700CrossRefPubMedPubMedCentralGoogle Scholar
  30. Wells PS et al (2000) Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 83(3):416–420PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Institut für Klinische RadiologieKlinikum der Universität München (LMU)MünchenGermany

Personalised recommendations