Open AccessEvaluation of acute chest pain: Evolving paradigm of coronary risk scores and imaging
Author(s) -
Edris Alderwish,
Emily Schultz,
Zain Kassam,
Michael Poon,
Neil L. Coplan
Publication year - 2019
Publication title -
reviews in cardiovascular medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.555
H-Index - 39
eISSN - 2153-8174
pISSN - 1530-6550
DOI - 10.31083/j.rcm.2019.04.589
Subject(s) - medicine , chest pain , acute coronary syndrome , timi , fractional flow reserve , triage , modalities , etiology , emergency department , differential diagnosis , troponin , radiology , cardiac imaging , cardiology , coronary artery disease , intensive care medicine , coronary angiography , myocardial infarction , emergency medicine , thrombolysis , pathology , social science , psychiatry , sociology
There is a broad differential diagnosis for patients presenting with acute chest pain. History, physical examination, electrocardiogram, and serial troponin assays are pivotal in assessing patients with suspected acute coronary syndrome. However, if the initial workup is equivocal, physicians are faced with a challenge to find the optimal strategy for further triage. Risk stratification scores have been validated for patients with known acute coronary syndrome, such as the TIMI and GRACE scores, but there may be limitations in undifferentiated chest pain patients. Advancements in imaging modalities such as coronary computed tomography angiography and the addition CT derived fractional flow reserve, have demonstrated utility in evaluating patients presenting with acute chest pain. With this article, we aim to provide a comprehensive review of the non-invasive modalities that are available to evaluate acute chest pain patients suspected of cardiac etiology in the emergency room. We also added a focus on new imaging modalities that have shown to have prognostic implications in stable ischemic heart disease.