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Transthoracic echocardiography for the evaluation of chest pain in the emergency department

Neil J Weissman, MD
Section Editor
Warren J Manning, MD
Deputy Editor
Brian C Downey, MD, FACC


Accurate assessment of chest pain in the emergency department requires a thorough knowledge of the differential diagnosis and appropriate use of diagnostic tools. It is essential not to miss an aortic dissection, pulmonary embolus, or acute myocardial infarction, and to avoid overtreating pericarditis or musculoskeletal pain. Transthoracic echocardiography (TTE) is often underutilized in this setting. TTE has the advantages of being readily accessible, portable, noninvasive, and fast; it may detect significant findings that are misdiagnosed or not detected on initial clinical evaluation. In one study of 124 patients, it identified a patient with a significant abnormality with a sensitivity, specificity, positive and negative predictive value, and overall accuracy of 84, 88, 89, 83, and 86 percent, respectively [1].

In 2003, a task force of the American College of Cardiology (ACC), the American Heart Association (AHA), and the American Society of Echocardiography (ASE) recommended echocardiography in patients with chest pain in the following settings [2]:

For diagnosis of underlying cardiac disease in patients with chest pain and clinical evidence of valvular, pericardial, or myocardial disease

For evaluation of chest pain in patients with suspected acute myocardial ischemia, when baseline ECG and other laboratory markers are nondiagnostic and when the study can be obtained during pain or within minutes after its abatement

For evaluation of chest pain in patients with suspected aortic dissection

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Literature review current through: Nov 2017. | This topic last updated: Oct 21, 2015.
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