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Use of Multislice CT for the Evaluation of Patients with Chest Pain

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Short Stay Management of Chest Pain

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

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Abstract

Approximately 6 million patients are evaluated annually in emergency departments (ED) for acute chest pain and constitute up to 10% of all ED admissions in the USA (McCaig, National Hospital Ambulatory Medical Care Survey 2003: emergency department summary: advance data from vital and health statistics, No. 358. National Center for Health Statistics, 2005; Bhuiya et al., NCHS Data Brief 43:1–8, 2010). The differential diagnosis is vast and includes coronary, pulmonary, pericardial, and aortic diseases, thus posing a significant diagnostic challenge. The primary diagnostic goal is to exclude life threatening causes such as acute coronary syndrome (ACS), since an estimated 2% of these patients are inappropriately sent home and suffer higher morbidity than admitted patients (Lee and Goldman, N Engl J Med 342(16):1187–1195, 2000; Pope et al., N Engl J Med 342(16):1163–1170, 2000). Missed ACS was the number one payout per malpractice case, and accounts for 41% of claims paid. Although only a small percentage of acute chest pain patients with a normal electrocardiogram (EKG) and cardiac enzymes suffer from ACS, there is a large cost burden borne by the health-care system in evaluating these patients, estimated to be around $10–13 billion annually in the United States alone (McCaig, National Hospital Ambulatory Medical Care Survey 2003: emergency department summary: advance data from vital and health statistics, No. 358. National Center for Health Statistics, 2005).

Rapid advances in multirow detector computed tomographic (CT) technology commonly known as multislice CT (MSCT) has led to the utilization of the coronary CT angiography (CCTA) in the ED as a tool for triaging patients presenting with acute chest pain. The direct visualization of the coronary anatomy, the ability to simultaneously image the rest of the thorax to exclude aortic dissection and pulmonary embolism, and the ability to provide alternate causes of chest pain, such as pneumonia, pericardial fluid and esophageal inflammation, make this modality attractive to the practitioner. This chapter will examine the use of CCTA for the evaluation of acute chest pain.

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Acknowledgements

Images obtained courtesy Samuel Johnson MD (Interim Chair, Department of Radiology, Wayne State University, Detroit, Michigan, USA) and Aiden Abidov MD PhD (Section Chief, Cardiology, VA Hospital Detroit, Michigan, USA. Department of Medicine/ Division of Cardiology, Wayne State University, Detroit, Michigan, USA).

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Authors and Affiliations

  1. Department of Emergency Medicine, Wayne State University, Detroit, MI, USA

    Vijaya Arun Kumar & Brian O’Neil

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  1. Vijaya Arun Kumar
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  2. Brian O’Neil
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Correspondence to Brian O’Neil .

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Editors and Affiliations

  1. School of Medicine, Wayne State University, Grosse Pointe Park, MI, USA

    Margarita Pena

  2. School of Medicine, Emory University, Decatur, GA, USA

    Anwar Osborne

  3. Baylor College of Medicine, Houston, TX, USA

    W. Frank Peacock

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Kumar, V.A., O’Neil, B. (2022). Use of Multislice CT for the Evaluation of Patients with Chest Pain. In: Pena, M., Osborne, A., Peacock, W.F. (eds) Short Stay Management of Chest Pain. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-031-05520-1_15

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  • DOI: https://doi.org/10.1007/978-3-031-05520-1_15

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