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| ==Echocardiography/Ultrasound== | | ==Echocardiography/Ultrasound== |
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| ===Electrocardiography===
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| An electrocardiogram is very useful for the diagnosis of several etiologies of chest pain such as;
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| ====[[Acute coronary syndromes|Acute coronary syndrome]]====
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| *A standard 12 lead ECG is recommended in all patients with chest pain within 10 minutes of presentation if acute coronary syndrome is suspected<ref name="pmid3661390">{{cite journal |vauthors=Slater DK, Hlatky MA, Mark DB, Harrell FE, Pryor DB, Califf RM |title=Outcome in suspected acute myocardial infarction with normal or minimally abnormal admission electrocardiographic findings |journal=Am. J. Cardiol. |volume=60 |issue=10 |pages=766–70 |date=October 1987 |pmid=3661390 |doi=10.1016/0002-9149(87)91020-4 |url=}}</ref><ref name="pmid3920520">{{cite journal |vauthors=Brush JE, Brand DA, Acampora D, Chalmer B, Wackers FJ |title=Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction |journal=N. Engl. J. Med. |volume=312 |issue=18 |pages=1137–41 |date=May 1985 |pmid=3920520 |doi=10.1056/NEJM198505023121801 |url=}}</ref>.
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| *Findings on ECG suggestive of ACS include<ref name="pmid3970650">{{cite journal |vauthors=Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L |title=Acute chest pain in the emergency room. Identification and examination of low-risk patients |journal=Arch. Intern. Med. |volume=145 |issue=1 |pages=65–9 |date=January 1985 |pmid=3970650 |doi= |url=}}</ref><ref name="O'GaraKushner2013">{{cite journal|last1=O'Gara|first1=Patrick T.|last2=Kushner|first2=Frederick G.|last3=Ascheim|first3=Deborah D.|last4=Casey|first4=Donald E.|last5=Chung|first5=Mina K.|last6=de Lemos|first6=James A.|last7=Ettinger|first7=Steven M.|last8=Fang|first8=James C.|last9=Fesmire|first9=Francis M.|last10=Franklin|first10=Barry A.|last11=Granger|first11=Christopher B.|last12=Krumholz|first12=Harlan M.|last13=Linderbaum|first13=Jane A.|last14=Morrow|first14=David A.|last15=Newby|first15=L. Kristin|last16=Ornato|first16=Joseph P.|last17=Ou|first17=Narith|last18=Radford|first18=Martha J.|last19=Tamis-Holland|first19=Jacqueline E.|last20=Tommaso|first20=Carl L.|last21=Tracy|first21=Cynthia M.|last22=Woo|first22=Y. Joseph|last23=Zhao|first23=David X.|title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction|journal=Journal of the American College of Cardiology|volume=61|issue=4|year=2013|pages=e78–e140|issn=07351097|doi=10.1016/j.jacc.2012.11.019}}</ref>, [[ST elevation]], [[ST depression]] and a new [[left bundle branch block]] ([[LBBB]])
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| *It is important to note that a normal ECG does not rule out the presence of an acute myocardial infarction as ECG can show a hyper-acute [[T wave]]<ref name="pmid11992348">{{cite journal |author=Somers MP, Brady WJ, Perron AD, Mattu A |title=The prominant T wave: electrocardiographic differential diagnosis |journal=Am J Emerg Med |volume=20 |issue=3 |pages=243–51 |year=2002 |month=May |pmid=11992348 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735675702921935}}</ref><ref name="ACS_Clin_NA">Smith SW, Whitwam W. "Acute Coronary Syndromes." ''Emerg Med Clin N Am'' 2006; '''24(1)''': 53-89. PMID 16308113</ref> <ref name="ECG_Noncardiac">"The clinical value of the ECG in noncardiac conditions." ''Chest'' 2004; '''125(4)''': 1561-76. PMID 15078775</ref> as an early presentation.
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| *If an initial ECG is non-diagnostic and there is still a high clinical suspicion of an MI, a repeat ECG should be conducted.
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| *It is helpful to have precious ECGs of a patient to determine if findings observed are new.
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| Shown below is an EKG demonstrating clear [[ST elevation]] in the right [[precordial lead]]s depicting STEMI. A [[coronary angiography]] revealed a proximal right coronary artery occlusion<ref name="urlST elevation myocardial infarction electrocardiogram - wikidoc">{{cite web |url=https://www.wikidoc.org/index.php/ST_elevation_myocardial_infarction_electrocardiogram |title=ST elevation myocardial infarction electrocardiogram - wikidoc |format= |work= |accessdate=}}</ref>.
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| [[Image:STEMI 20 a.jpg|center|500px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| '''For more EKG examples of ST elevation myocardial infarction click [[ST elevation myocardial infarction EKG examples|here]]'''
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| ====[[Pericarditis]]====
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| *ECG findings in patients with [[Pericarditis|pericarditi]]<nowiki/>s may mirror that seen in [[acute myocardial infarction]] and carrying changes may be seen as the disease progresses.
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| *Findings on ECG suggestive of pericarditis at different levels include<ref name="urlPericarditis electrocardiogram - wikidoc">{{cite web |url=https://www.wikidoc.org/index.php/Pericarditis_electrocardiogram |title=Pericarditis electrocardiogram - wikidoc |format= |work= |accessdate=}}</ref>,
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| *Stage I: ST elevation in all leads; PTa depression (depression between the end of the [[P wave]] and the beginning of the [[QRS]] complex)
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| *Stage II: Pseudonormalization (transition)
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| *Stage III: Inverted [[T waves]]
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| *Stage IV: Normalization
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| [[Image:Stadia pericarditis.png|center|500px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| ==References== | | ==References== |