Acute Coronary Syndrome and Other Life-Threatening Conditions

Cardiovascular Causes

The European Society of Cardiology recommends that a patient with persistent chest pain >20 minutes and ST elevation on ECG should be diagnosed with ST-elevation myocardial infarction (STEMI) 1, 2
The American Heart Association suggests that a patient with typical chest pain and elevated troponin but no persistent ST elevation should be diagnosed with non-ST elevation myocardial infarction (NSTEMI) 1, 3
The American College of Cardiology recommends that a patient with ischemic pain at rest or with minimal exertion without myocardial necrosis should be diagnosed with unstable angina 1, 3
Typical chest pain is described as pressure, oppression, or heaviness retrosternal that may radiate to the left arm, right arm, both arms, neck, jaw, or back, with an associated symptom of diaphoresis having a specificity of 95% and a likelihood ratio (LR) of 5.18 for acute coronary syndrome (ACS) 3, 4, 5

The American Heart Association suggests that a patient with sudden, tearing chest pain radiating to the upper or lower back, and a history of hypertension, bicuspid aortic valve, or Marfan syndrome, should be evaluated for aortic dissection 5, 6
A patient with pleuritic chest pain associated with dyspnea and tachycardia in >90% of patients should be evaluated for pulmonary embolism 5, 6
The European Society of Cardiology recommends that a patient with sharp, pleuritic chest pain that worsens in the supine position and improves when sitting up and leaning forward should be diagnosed with acute pericarditis 3, 5, 6

The American College of Cardiology recommends an ECG within 10 minutes to identify STEMI, ST depression, or ischemic changes, and troponin measurement immediately and repeated according to protocol 1, 3, 5, 6
A chest radiograph should be performed to evaluate for mediastinal widening (dissection), pneumothorax, or pneumonia 3, 7
If pulmonary embolism or dissection is suspected, a contrast-enhanced chest CT should be performed 7