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Initial evaluation and management of suspected acute coronary syndrome (myocardial infarction, unstable angina) in the emergency department

Authors
Guy S Reeder, MD
Eric Awtry, MD
Simon A Mahler, MD, MS
Section Editors
James Hoekstra, MD
Christopher P Cannon, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

The clinical presentation of myocardial ischemia is most often acute chest discomfort. The goal of emergency department evaluation is to determine the cause of the chest discomfort and promptly initiate appropriate therapy. It is essential that initial assessment and management be rapid but methodical and evidence-based.

Diagnostic evaluation emphasizes distinguishing among the following potential causes of chest pain:

Acute coronary syndrome (myocardial infarction or unstable angina)

Nonischemic chest pain, including potentially life-threatening conditions such as aortic dissection, pulmonary embolism, and esophageal rupture (table 1 and table 2A-B)

The diagnosis of acute coronary ischemia depends upon the characteristics of the chest pain, specific associated symptoms, abnormalities on electrocardiogram (ECG), and levels of serum markers of cardiac injury. A patient with a possible acute coronary syndrome (ACS) should be treated rapidly. Thus, initial management steps must be undertaken before or during the time the diagnosis is being established.

                              

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 03 00:00:00 GMT+00:00 2016.
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