Acute coronary syndromes: how to make a correct diagnosis in the emergency room

Abstract

The assessment of patients with chest pain or other symptomssuggestive of myocardial ischemia continues as one of the greatestchallenges for physicians who work in emergency units. Although thedoctor’s experience is relevant, the evaluation of chest pain patients isfrequently made in a subjective and inefficient manner when specificdiagnostic protocols are not applied. This leads to unnecessaryhospitalizations and high hospital expenditures. Our objective is tofurnish simple tools that can be easily applied in daily clinical practiceas guidelines for managing patients with chest pain in emergencycenters. We describe three steps for a correct diagnosis of patients withprecordial pain, based on medical history, physical examination, andancillary tests. These stages include the initial clinical analysis and theuse of a specific diagnostic protocol, if necessary. Finally, we presentthe protocol model implemented at our emergency care center.

Keywords

• Myocardial ischemia/diagnosis
• Chest pain
• Myocardial infarction/diagnosis
• Emergency service
• hospital
• Emergency medical services