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The approach to patients with possible cardiac chest pain
Author(s) -
Parsonage William A,
Cullen Louise,
Younger John F
Publication year - 2013
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja12.11171
Subject(s) - chest pain , medicine , acute coronary syndrome , myocardial infarction , intensive care medicine , emergency department , medical emergency , risk stratification , clinical practice , presentation (obstetrics) , emergency medicine , physical therapy , surgery , psychiatry
Summary Chest pain is a common reason for presentation in hospital emergency departments and general practice. Some patients presenting with chest pain to emergency departments and, to a lesser extent, general practice will be found to have a life‐threatening cause, but most will not. The challenge is to identify those who do in a safe, timely and cost‐effective manner. An acute coronary syndrome cannot be excluded on clinical grounds alone. In patients with ongoing symptoms of chest pain, without an obvious other cause, ST‐segment‐elevation myocardial infarction should be excluded with a 12‐lead electrocardiogram at the first available opportunity. Significant recent advances in the clinical approach to patients with acute chest pain, including better understanding of risk stratification, increasingly sensitive cardiac biomarkers and new non‐invasive tests for coronary disease, can help clinicians minimise the risk of unexpected short‐term adverse cardiac events. An approach that integrates these advances is needed to deliver the best outcomes for patients with chest pain. All hospital emergency departments should adopt such a strategic approach, and general practitioners should be aware of when and how to access these facilities.