The Acute Chest Pain Unit

Abstract

BACKGROUND:Chest pain is one of the most common reasons for visiting the Emergency Department (ED). Chest symptoms are common and are caused by numerous benign to life-threatening conditions and the challenge for ED physicians is to accurately and efficiently identify the small proportion of patients with myocardial infarction or other life-threatening conditions. Unfortunately, neither clinical presentation, traditional cardiovascular risk factors, nor clinical risk scores allow for a safe initial decision, which requires the implementation of a new diagnostic strategy.

LEARNING POINTS:

• To learn why a new diagnostic algorithm is needed for an early and precise diagnosis of patients with intermediate and low risk for life-threatening chest diseases;
• To learn about the possibilities of multidetector computed tomography (MDCT) to accurately detect and stratify patients with acute chest pain syndromes, to reduce the time delay for diagnosis and to maximize diagnostic and therapeutic alternatives and thereby improve outcomes;
• To discuss the cost effectiveness and applicability of the triple-rule-out protocol in the clinical scenario as well as the readiness of radiologist to provide coverage of the acute chest pain unit.

CONCLUSION:MDCT is a viable alternative to clinical and functional testing in the work-up of patients presenting with acute chest pain to the Emergency Department. More and more the new diagnostic algorithm for ruling out patients with devastating chest diseases is included in the standards.