Vascular: Extended chest pain protocol

Abstract

The most important differential diagnoses of acute chest pain include myocardial infarction, aortic dissection or aneurysm and pulmonary embolism. The first diagnostic measures recommended by the American College of Emergency Physicians guidelines as well as the American College of Radiology Appropriateness Criteria on Acute Chest Pain are electrocardiograms (ECG) and serum cardiac markers. Further examinations, such as chest x-ray, ventilation / perfusion scan, resting myocardial perfusion scan, echocardiography, CT, aortic imaging or pulmonary angiography depend on the patient's history. However, patients' initial symptoms often do not display the characteristic signs, and the various examinations needed to make a diagnosis can be very time consuming and expensive. Therefore, examinations should focus initially on ruling out acute life-threatening conditions, including acute ischemic heart disease, aortic dissection and pulmonary embolism. © 2008 Springer Medizin Verlag Heidelberg.