She has soft, bibasilar inspiratory crackles on pulmonary examination.
She is hypertensive, but her vital signs are otherwise normal. ACS seems unlikely, but as you’re thinking through your differential diagnosis, you wonder if you need to do any other tests to rule it out definitively.Ī 46-year-old woman with end-stage renal disease, hypertension, diabetes, and tobacco use presents with dull, aching, substernal chest pain radiating to her arms and shortness of breath that began shortly after completing dialysis. He has no past medical history, no cardiac risk factors, and no family history of heart disease. His vital signs and physical examination are normal. He feels that his chest pain is worse when lying flat, and is concerned he’s having a heart attack. He recently returned from a spring break trip to Mexico and reports symptoms of an upper respiratory infection. You hesitate and wonder if it would be safe to send him home without further testing.Ī 22-year-old college student presents with sharp, left-sided chest pain and shortness of breath. When you go back into the room to reassess him, he says he feels fine and asks if he can go home. His ECG, chest x-ray, and troponin are all normal. He is pain-free on arrival, and his vital signs are unremarkable. His wife tells you that he’s been having similar episodes on and off for the past 2 weeks. Case PresentationĪ 65-year-old man with a history of hypertension, diabetes, and prior myocardial infarction presents to the ED after he experienced a 20-minute episode of dull, aching, left-sided chest discomfort while doing yard work an hour ago. The emerging role of new technologies, such as high-sensitivity troponin assays and advanced imaging techniques, are also presented. Clinical risk scores are discussed, as well as the evidence and indications for confirmatory testing. From the prehospital care setting to disposition and follow-up, this systematic review addresses the fundamentals of the emergency department evaluation of patients determined to be at low risk for acute coronary syndromes or adverse outcomes. Though a minority of patients presenting to the emergency department with chest pain have acute coronary syndromes, identifying the patients who may be safely discharged and determining whether further testing is needed remains challenging. Summary of Major Clinical Risk Scores (Derivation Studies Only) (Continued from page 14) Summary of Major Clinical Risk Scores (Derivation Studies Only) (Continued on page 15)Īppendix 1.
#Timi risk score for acs serial
Serial Electrocardiograms in a Patient With Acute Left Anterior Descending Artery OcclusionĪppendix 1. Estimated Diagnostic Accuracy of Confirmatory Testing for Detection of Coronary Artery Disease With ≥ 50% Stenosisįigure 1. Summary of the TIMI Score and HEART Score Electrocardiographic Classification and Likelihood of 30-day Major Adverse Cardiac Event
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