Chest pain diagnostic study of choice: Difference between revisions

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*'''According to the suspected etiology of the chest pain:'''
*'''According to the suspected etiology of the chest pain:'''
**There is no single diagnostic study of choice for the diagnosis of chest pain caused by acute coronary syndrome, however ECG and cardiac enzymes are the ''most important initial test'', Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) suggest the ECG be obtained and interpreted within 10 minutes of patient presentation in the ED.<ref name="Guideliness">{{cite journal|title=2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines|journal=Circulation|volume=127|issue=23|year=2013|pages=e663–e828|issn=0009-7322|doi=10.1161/CIR.0b013e31828478ac}}</ref><ref name="pmid22809746">{{cite journal| author=Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE et al.| title=2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2012 | volume= 60 | issue= 7 | pages= 645-81 | pmid=22809746 | doi=10.1016/j.jacc.2012.06.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22809746  }}</ref><ref name="MontalescotSechtem2013">{{cite journal|last1=Montalescot|first1=G.|last2=Sechtem|first2=U.|last3=Achenbach|first3=S.|last4=Andreotti|first4=F.|last5=Arden|first5=C.|last6=Budaj|first6=A.|last7=Bugiardini|first7=R.|last8=Crea|first8=F.|last9=Cuisset|first9=T.|last10=Di Mario|first10=C.|last11=Ferreira|first11=J. R.|last12=Gersh|first12=B. J.|last13=Gitt|first13=A. K.|last14=Hulot|first14=J.-S.|last15=Marx|first15=N.|last16=Opie|first16=L. H.|last17=Pfisterer|first17=M.|last18=Prescott|first18=E.|last19=Ruschitzka|first19=F.|last20=Sabate|first20=M.|last21=Senior|first21=R.|last22=Taggart|first22=D. P.|last23=van der Wall|first23=E. E.|last24=Vrints|first24=C. J. M.|last25=Zamorano|first25=J. L.|last26=Achenbach|first26=S.|last27=Baumgartner|first27=H.|last28=Bax|first28=J. J.|last29=Bueno|first29=H.|last30=Dean|first30=V.|last31=Deaton|first31=C.|last32=Erol|first32=C.|last33=Fagard|first33=R.|last34=Ferrari|first34=R.|last35=Hasdai|first35=D.|last36=Hoes|first36=A. W.|last37=Kirchhof|first37=P.|last38=Knuuti|first38=J.|last39=Kolh|first39=P.|last40=Lancellotti|first40=P.|last41=Linhart|first41=A.|last42=Nihoyannopoulos|first42=P.|last43=Piepoli|first43=M. F.|last44=Ponikowski|first44=P.|last45=Sirnes|first45=P. A.|last46=Tamargo|first46=J. L.|last47=Tendera|first47=M.|last48=Torbicki|first48=A.|last49=Wijns|first49=W.|last50=Windecker|first50=S.|last51=Knuuti|first51=J.|last52=Valgimigli|first52=M.|last53=Bueno|first53=H.|last54=Claeys|first54=M. J.|last55=Donner-Banzhoff|first55=N.|last56=Erol|first56=C.|last57=Frank|first57=H.|last58=Funck-Brentano|first58=C.|last59=Gaemperli|first59=O.|last60=Gonzalez-Juanatey|first60=J. R.|last61=Hamilos|first61=M.|last62=Hasdai|first62=D.|last63=Husted|first63=S.|last64=James|first64=S. K.|last65=Kervinen|first65=K.|last66=Kolh|first66=P.|last67=Kristensen|first67=S. D.|last68=Lancellotti|first68=P.|last69=Maggioni|first69=A. P.|last70=Piepoli|first70=M. F.|last71=Pries|first71=A. R.|last72=Romeo|first72=F.|last73=Ryden|first73=L.|last74=Simoons|first74=M. L.|last75=Sirnes|first75=P. A.|last76=Steg|first76=P. G.|last77=Timmis|first77=A.|last78=Wijns|first78=W.|last79=Windecker|first79=S.|last80=Yildirir|first80=A.|last81=Zamorano|first81=J. L.|title=2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology|journal=European Heart Journal|volume=34|issue=38|year=2013|pages=2949–3003|issn=0195-668X|doi=10.1093/eurheartj/eht296}}</ref>
**There is no single diagnostic study of choice for the diagnosis of chest pain caused by [[Acute coronary syndromes|acute coronary syndrome]], however [[ECG]] and [[cardiac enzymes]] are the ''most important initial test'', Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) suggest the [[ECG]] be obtained and interpreted within 10 minutes of patient presentation in the [[ED]].<ref name="Guideliness">{{cite journal|title=2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines|journal=Circulation|volume=127|issue=23|year=2013|pages=e663–e828|issn=0009-7322|doi=10.1161/CIR.0b013e31828478ac}}</ref><ref name="pmid22809746">{{cite journal| author=Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE et al.| title=2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2012 | volume= 60 | issue= 7 | pages= 645-81 | pmid=22809746 | doi=10.1016/j.jacc.2012.06.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22809746  }}</ref><ref name="MontalescotSechtem2013">{{cite journal|last1=Montalescot|first1=G.|last2=Sechtem|first2=U.|last3=Achenbach|first3=S.|last4=Andreotti|first4=F.|last5=Arden|first5=C.|last6=Budaj|first6=A.|last7=Bugiardini|first7=R.|last8=Crea|first8=F.|last9=Cuisset|first9=T.|last10=Di Mario|first10=C.|last11=Ferreira|first11=J. R.|last12=Gersh|first12=B. J.|last13=Gitt|first13=A. K.|last14=Hulot|first14=J.-S.|last15=Marx|first15=N.|last16=Opie|first16=L. H.|last17=Pfisterer|first17=M.|last18=Prescott|first18=E.|last19=Ruschitzka|first19=F.|last20=Sabate|first20=M.|last21=Senior|first21=R.|last22=Taggart|first22=D. P.|last23=van der Wall|first23=E. E.|last24=Vrints|first24=C. J. M.|last25=Zamorano|first25=J. L.|last26=Achenbach|first26=S.|last27=Baumgartner|first27=H.|last28=Bax|first28=J. J.|last29=Bueno|first29=H.|last30=Dean|first30=V.|last31=Deaton|first31=C.|last32=Erol|first32=C.|last33=Fagard|first33=R.|last34=Ferrari|first34=R.|last35=Hasdai|first35=D.|last36=Hoes|first36=A. W.|last37=Kirchhof|first37=P.|last38=Knuuti|first38=J.|last39=Kolh|first39=P.|last40=Lancellotti|first40=P.|last41=Linhart|first41=A.|last42=Nihoyannopoulos|first42=P.|last43=Piepoli|first43=M. F.|last44=Ponikowski|first44=P.|last45=Sirnes|first45=P. A.|last46=Tamargo|first46=J. L.|last47=Tendera|first47=M.|last48=Torbicki|first48=A.|last49=Wijns|first49=W.|last50=Windecker|first50=S.|last51=Knuuti|first51=J.|last52=Valgimigli|first52=M.|last53=Bueno|first53=H.|last54=Claeys|first54=M. J.|last55=Donner-Banzhoff|first55=N.|last56=Erol|first56=C.|last57=Frank|first57=H.|last58=Funck-Brentano|first58=C.|last59=Gaemperli|first59=O.|last60=Gonzalez-Juanatey|first60=J. R.|last61=Hamilos|first61=M.|last62=Hasdai|first62=D.|last63=Husted|first63=S.|last64=James|first64=S. K.|last65=Kervinen|first65=K.|last66=Kolh|first66=P.|last67=Kristensen|first67=S. D.|last68=Lancellotti|first68=P.|last69=Maggioni|first69=A. P.|last70=Piepoli|first70=M. F.|last71=Pries|first71=A. R.|last72=Romeo|first72=F.|last73=Ryden|first73=L.|last74=Simoons|first74=M. L.|last75=Sirnes|first75=P. A.|last76=Steg|first76=P. G.|last77=Timmis|first77=A.|last78=Wijns|first78=W.|last79=Windecker|first79=S.|last80=Yildirir|first80=A.|last81=Zamorano|first81=J. L.|title=2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology|journal=European Heart Journal|volume=34|issue=38|year=2013|pages=2949–3003|issn=0195-668X|doi=10.1093/eurheartj/eht296}}</ref>
***The following result of '''ECG''' is confirmatory of '''Myocardial infarction''' in addition to the Pain described as a substernal pressure or crushing sensation radiated to the left arm, neck and/or jaw:
***The following result of '''[[ECG]]''' is confirmatory of '''[[Myocardial infarction]]''' in addition to the Pain described as a substernal pressure or crushing sensation radiated to the left arm, neck and/or jaw:
****ST- T wave changes, '''''OR'''''
****ST- T wave changes, '''''OR'''''
****New LBBB, '''''OR'''''
****New LBBB, '''''OR'''''
****New Q wave
****New Q wave


* Chest pain caused by [[pericarditis]]:<ref name="TomkowskiSwedberg2015">{{cite journal|last1=Tomkowski|first1=Witold|last2=Swedberg|first2=Karl|last3=Seferovic|first3=Petar|last4=Sabaté Tenas|first4=Manel|last5=Ristić|first5=Arsen D|last6=Pavie|first6=Alain|last7=Mayosi|first7=Bongani|last8=Maisch|first8=Bernhard|last9=Lionis|first9=Christos|last10=Klingel|first10=Karin|last11=Gueret|first11=Pascal|last12=Brucato|first12=Antonio|last13=Bogaert|first13=Jan|last14=Barón-Esquivias|first14=Gonzalo|last15=Badano|first15=Luigi|last16=Imazio|first16=Massimo|last17=Charron|first17=Philippe|last18=Adler|first18=Yehuda|last19=Achenbach|first19=Stephan|last20=Agewall|first20=Stefan|last21=Al-Attar|first21=Nawwar|last22=Angel Ferrer|first22=Juan|last23=Arad|first23=Michael|last24=Asteggiano|first24=Riccardo|last25=Bueno|first25=Héctor|last26=Caforio|first26=Alida L P|last27=Carerj|first27=Scipione|last28=Ceconi|first28=Claudio|last29=Evangelista|first29=Arturo|last30=Flachskampf|first30=Frank|last31=Giannakoulas|first31=George|last32=Gielen|first32=Stephan|last33=Habib|first33=Gilbert|last34=Kolh|first34=Philippe|last35=Lambrinou|first35=Ekaterini|last36=Lancellotti|first36=Patrizio|last37=Lazaros|first37=George|last38=Linhart|first38=Ales|last39=Meurin|first39=Philippe|last40=Nieman|first40=Koen|last41=Piepoli|first41=Massimo F|last42=Price|first42=Susanna|last43=Roos-Hesselink|first43=Jolien|last44=Roubille|first44=François|last45=Ruschitzka|first45=Frank|last46=Sagristà Sauleda|first46=Jaume|last47=Sousa-Uva|first47=Miguel|last48=Uwe Voigt|first48=Jens|last49=Luis Zamorano|first49=Jose|last50=Zamorano|first50=Jose Luis|last51=Aboyans|first51=Victor|last52=Achenbach|first52=Stephan|last53=Agewall|first53=Stefan|last54=Badimon|first54=Lina|last55=Barón-Esquivias|first55=Gonzalo|last56=Baumgartner|first56=Helmut|last57=Bax|first57=Jeroen J|last58=Bueno|first58=Héctor|last59=Carerj|first59=Scipione|last60=Dean|first60=Veronica|last61=Erol|first61=Çetin|last62=Fitzimons|first62=Donna|last63=Gaemperli|first63=Oliver|last64=Kirchhof|first64=Paulus|last65=Kolh|first65=Philippe|last66=Lancellotti|first66=Patrizio|last67=Lip|first67=Gregory YH|last68=Nihoyannopoulos|first68=Petros|last69=Piepoli|first69=Massimo F|last70=Ponikowski|first70=Piotr|last71=Roffi|first71=Marco|last72=Torbicki|first72=Adam|last73=Vaz Carneiro|first73=Antonio|last74=Windecker|first74=Stephan|last75=Shuka|first75=Naltin|last76=Sisakian|first76=Hamayak|last77=Mascherbauer|first77=Julia|last78=Isayev|first78=Elnur|last79=Shumavets|first79=Vadim|last80=Van Camp|first80=Guy|last81=Gatzov|first81=Plamen|last82=Hanzevacki|first82=Jadranka Separovic|last83=Moustra|first83=Hera Heracleous|last84=Linhart|first84=Ales|last85=Møller|first85=Jacob Eifer|last86=Aboleineen|first86=Mohamed Wafaie|last87=Põder|first87=Pentti|last88=Lehtonen|first88=Jukka|last89=Antov|first89=Slobodan|last90=Damy|first90=Thibaud|last91=Schieffer|first91=Bernhard|last92=Dimitriadis|first92=Kyriakos|last93=Kiss|first93=Robert Gabor|last94=Rafnsson|first94=Arnar|last95=Arad|first95=Michael|last96=Novo|first96=Salvatore|last97=Mirrakhimov|first97=Erkin|last98=Stradinš|first98=Peteris|last99=Kavoliuniene|first99=Ausra|last100=Codreanu|first100=Andrei|last101=Dingli |first101=Philip|last102=Vataman|first102=Eleonora|last103=El Hattaoui|first103=Mustapaha|last104=Samstad|first104=Stein Olav|last105=Hoffman|first105=Piotr|last106=Lopes|first106=Luís Rocha|last107=Dimulescu|first107=Doina Ruxandra|last108=Arutyunov|first108=Grigory P|last109=Pavlovic|first109=Milan|last110=Dúbrava|first110=Juraj|last111=Sauleda|first111=Jaume Sagristà|last112=Andersson|first112=Bert|last113=Müller|first113=Hajo|last114=Bouma|first114=Berto J|last115=Abaci|first115=Adnan|last116=Archbold|first116=Andrew|last117=Nesukay|first117=Elena|title=2015 ESC Guidelines for the diagnosis and management of pericardial diseases|journal=European Heart Journal|volume=36|issue=42|year=2015|pages=2921–2964|issn=0195-668X|doi=10.1093/eurheartj/ehv318}}</ref>
*Chest pain caused by [[pericarditis]]:<ref name="TomkowskiSwedberg2015">{{cite journal|last1=Tomkowski|first1=Witold|last2=Swedberg|first2=Karl|last3=Seferovic|first3=Petar|last4=Sabaté Tenas|first4=Manel|last5=Ristić|first5=Arsen D|last6=Pavie|first6=Alain|last7=Mayosi|first7=Bongani|last8=Maisch|first8=Bernhard|last9=Lionis|first9=Christos|last10=Klingel|first10=Karin|last11=Gueret|first11=Pascal|last12=Brucato|first12=Antonio|last13=Bogaert|first13=Jan|last14=Barón-Esquivias|first14=Gonzalo|last15=Badano|first15=Luigi|last16=Imazio|first16=Massimo|last17=Charron|first17=Philippe|last18=Adler|first18=Yehuda|last19=Achenbach|first19=Stephan|last20=Agewall|first20=Stefan|last21=Al-Attar|first21=Nawwar|last22=Angel Ferrer|first22=Juan|last23=Arad|first23=Michael|last24=Asteggiano|first24=Riccardo|last25=Bueno|first25=Héctor|last26=Caforio|first26=Alida L P|last27=Carerj|first27=Scipione|last28=Ceconi|first28=Claudio|last29=Evangelista|first29=Arturo|last30=Flachskampf|first30=Frank|last31=Giannakoulas|first31=George|last32=Gielen|first32=Stephan|last33=Habib|first33=Gilbert|last34=Kolh|first34=Philippe|last35=Lambrinou|first35=Ekaterini|last36=Lancellotti|first36=Patrizio|last37=Lazaros|first37=George|last38=Linhart|first38=Ales|last39=Meurin|first39=Philippe|last40=Nieman|first40=Koen|last41=Piepoli|first41=Massimo F|last42=Price|first42=Susanna|last43=Roos-Hesselink|first43=Jolien|last44=Roubille|first44=François|last45=Ruschitzka|first45=Frank|last46=Sagristà Sauleda|first46=Jaume|last47=Sousa-Uva|first47=Miguel|last48=Uwe Voigt|first48=Jens|last49=Luis Zamorano|first49=Jose|last50=Zamorano|first50=Jose Luis|last51=Aboyans|first51=Victor|last52=Achenbach|first52=Stephan|last53=Agewall|first53=Stefan|last54=Badimon|first54=Lina|last55=Barón-Esquivias|first55=Gonzalo|last56=Baumgartner|first56=Helmut|last57=Bax|first57=Jeroen J|last58=Bueno|first58=Héctor|last59=Carerj|first59=Scipione|last60=Dean|first60=Veronica|last61=Erol|first61=Çetin|last62=Fitzimons|first62=Donna|last63=Gaemperli|first63=Oliver|last64=Kirchhof|first64=Paulus|last65=Kolh|first65=Philippe|last66=Lancellotti|first66=Patrizio|last67=Lip|first67=Gregory YH|last68=Nihoyannopoulos|first68=Petros|last69=Piepoli|first69=Massimo F|last70=Ponikowski|first70=Piotr|last71=Roffi|first71=Marco|last72=Torbicki|first72=Adam|last73=Vaz Carneiro|first73=Antonio|last74=Windecker|first74=Stephan|last75=Shuka|first75=Naltin|last76=Sisakian|first76=Hamayak|last77=Mascherbauer|first77=Julia|last78=Isayev|first78=Elnur|last79=Shumavets|first79=Vadim|last80=Van Camp|first80=Guy|last81=Gatzov|first81=Plamen|last82=Hanzevacki|first82=Jadranka Separovic|last83=Moustra|first83=Hera Heracleous|last84=Linhart|first84=Ales|last85=Møller|first85=Jacob Eifer|last86=Aboleineen|first86=Mohamed Wafaie|last87=Põder|first87=Pentti|last88=Lehtonen|first88=Jukka|last89=Antov|first89=Slobodan|last90=Damy|first90=Thibaud|last91=Schieffer|first91=Bernhard|last92=Dimitriadis|first92=Kyriakos|last93=Kiss|first93=Robert Gabor|last94=Rafnsson|first94=Arnar|last95=Arad|first95=Michael|last96=Novo|first96=Salvatore|last97=Mirrakhimov|first97=Erkin|last98=Stradinš|first98=Peteris|last99=Kavoliuniene|first99=Ausra|last100=Codreanu|first100=Andrei|last101=Dingli |first101=Philip|last102=Vataman|first102=Eleonora|last103=El Hattaoui|first103=Mustapaha|last104=Samstad|first104=Stein Olav|last105=Hoffman|first105=Piotr|last106=Lopes|first106=Luís Rocha|last107=Dimulescu|first107=Doina Ruxandra|last108=Arutyunov|first108=Grigory P|last109=Pavlovic|first109=Milan|last110=Dúbrava|first110=Juraj|last111=Sauleda|first111=Jaume Sagristà|last112=Andersson|first112=Bert|last113=Müller|first113=Hajo|last114=Bouma|first114=Berto J|last115=Abaci|first115=Adnan|last116=Archbold|first116=Andrew|last117=Nesukay|first117=Elena|title=2015 ESC Guidelines for the diagnosis and management of pericardial diseases|journal=European Heart Journal|volume=36|issue=42|year=2015|pages=2921–2964|issn=0195-668X|doi=10.1093/eurheartj/ehv318}}</ref>
** [https://www.wikidoc.org/index.php/The_electrocardiogram ECG] is recommended in all [https://www.wikidoc.org/index.php/Patients patients] with suspected [https://www.wikidoc.org/index.php/Acute_pericarditis acute pericarditis].
**[https://www.wikidoc.org/index.php/The_electrocardiogram ECG] is recommended in all [https://www.wikidoc.org/index.php/Patients patients] with suspected [https://www.wikidoc.org/index.php/Acute_pericarditis acute pericarditis].
** [https://www.wikidoc.org/index.php/Transthoracic_echocardiography Transthoracic echocardiography] is recommended in all [https://www.wikidoc.org/index.php/Patients patients] with suspected [https://www.wikidoc.org/index.php/Acute_pericarditis acute pericarditis].
**[https://www.wikidoc.org/index.php/Transthoracic_echocardiography Transthoracic echocardiography] is recommended in all [https://www.wikidoc.org/index.php/Patients patients] with suspected [https://www.wikidoc.org/index.php/Acute_pericarditis acute pericarditis].
** [https://www.wikidoc.org/index.php/Chest_X-rays Chest X-ray] is recommended in all [https://www.wikidoc.org/index.php/Patients patients] with suspected [https://www.wikidoc.org/index.php/Acute_pericarditis acute pericarditis].
**[https://www.wikidoc.org/index.php/Chest_X-rays Chest X-ray] is recommended in all [https://www.wikidoc.org/index.php/Patients patients] with suspected [https://www.wikidoc.org/index.php/Acute_pericarditis acute pericarditis].
** Assessment of markers of [https://www.wikidoc.org/index.php/Inflammation inflammation] (i.e. [https://www.wikidoc.org/index.php/C-reactive_protein CRP]) and [https://www.wikidoc.org/index.php/Myocardial_injury myocardial injury] (i.e. [https://www.wikidoc.org/index.php/CK CK], [https://www.wikidoc.org/index.php/Troponin troponin]) is recommended in [https://www.wikidoc.org/index.php/Patients patients] with suspected [https://www.wikidoc.org/index.php/Acute_pericarditis acute pericarditis].
**Assessment of markers of [https://www.wikidoc.org/index.php/Inflammation inflammation] (i.e. [https://www.wikidoc.org/index.php/C-reactive_protein CRP]) and [https://www.wikidoc.org/index.php/Myocardial_injury myocardial injury] (i.e. [https://www.wikidoc.org/index.php/CK CK], [https://www.wikidoc.org/index.php/Troponin troponin]) is recommended in [https://www.wikidoc.org/index.php/Patients patients] with suspected [https://www.wikidoc.org/index.php/Acute_pericarditis acute pericarditis]. read more about recommendations for the general diagnostic work-up of pericardial diseases,[[Pericarditis laboratory studies|here]].
 
*[[Chest X-ray]] is the gold standard test for the diagnosis of [[pneumothorax]] or [[pneumonia]].<ref name="MandellWunderink2007">{{cite journal|last1=Mandell|first1=Lionel A.|last2=Wunderink|first2=Richard G.|last3=Anzueto|first3=Antonio|last4=Bartlett|first4=John G.|last5=Campbell|first5=G. Douglas|last6=Dean|first6=Nathan C.|last7=Dowell|first7=Scott F.|last8=File|first8=Thomas M.|last9=Musher|first9=Daniel M.|last10=Niederman|first10=Michael S.|last11=Torres|first11=Antonio|last12=Whitney|first12=Cynthia G.|title=Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults|journal=Clinical Infectious Diseases|volume=44|issue=Supplement_2|year=2007|pages=S27–S72|issn=1537-6591|doi=10.1086/511159}}</ref> You can read more about diagnostic criteria for severe [[Community-acquired pneumonia|community acquired pneumonia]] in adults, [[Pneumonia diagnostic criteria|here]].
<br />
**Order a [[chest X-ray]] if the patient presents with any of the following:
 
***[[Fever]] (>37.8° C / 100° F)
**Chest X-ray  is the gold standard test for the diagnosis of pneumothorax or pneumonia.<ref name="MandellWunderink2007">{{cite journal|last1=Mandell|first1=Lionel A.|last2=Wunderink|first2=Richard G.|last3=Anzueto|first3=Antonio|last4=Bartlett|first4=John G.|last5=Campbell|first5=G. Douglas|last6=Dean|first6=Nathan C.|last7=Dowell|first7=Scott F.|last8=File|first8=Thomas M.|last9=Musher|first9=Daniel M.|last10=Niederman|first10=Michael S.|last11=Torres|first11=Antonio|last12=Whitney|first12=Cynthia G.|title=Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults|journal=Clinical Infectious Diseases|volume=44|issue=Supplement_2|year=2007|pages=S27–S72|issn=1537-6591|doi=10.1086/511159}}</ref> You can read more about diagnostic criteria for severe community acquired pneumonia in adults, [[Pneumonia diagnostic criteria|here]].
***[[Tachypnea]] (> 20 breaths/min)
***Order a chest X-ray if the patient presents with any of the following:
***[[Tachycardia]] (> 100 bpm)
****Fever (>37.8° C / 100° F)
***Decreased [[breath sounds]] and [[crackles]] in the physical exam.
****Tachypnea (> 20 breaths/min)
*[[Echocardiography]] is the gold standard test for the diagnosis of [[aortic stenosis]] or [[aortic dissection]].
****Tachycardia (> 100 bpm)
*Diagnosis of [[pulmonary embolism]] based on signs and symptoms is difficult ,however the physician can use the Wells criteria to estimate the patient's likelihood of [[pulmonary embolism]] and accordingly further testing should be performed (e.g., [[d-dimer]] assay, [[Ventilation/perfusion scan|ventilation-perfusion scan]], helical computed tomography of the [[pulmonary arteries]]).<ref name="WellsAnderson2001">{{cite journal|last1=Wells|first1=Philip S.|last2=Anderson|first2=David R.|last3=Rodger|first3=Marc|last4=Stiell|first4=Ian|last5=Dreyer|first5=Jonathan F.|last6=Barnes|first6=David|last7=Forgie|first7=Melissa|last8=Kovacs|first8=George|last9=Ward|first9=John|last10=Kovacs|first10=Michael J.|title=Excluding Pulmonary Embolism at the Bedside without Diagnostic Imaging: Management of Patients with Suspected Pulmonary Embolism Presenting to the Emergency Department by Using a Simple Clinical Model and d-dimer|journal=Annals of Internal Medicine|volume=135|issue=2|year=2001|pages=98|issn=0003-4819|doi=10.7326/0003-4819-135-2-200107170-00010}}</ref><ref name="TamarizEng2004">{{cite journal|last1=Tamariz|first1=Leonardo J.|last2=Eng|first2=John|last3=Segal|first3=Jodi B.|last4=Krishnan|first4=Jerry A.|last5=Bolger|first5=Dennis T.|last6=Streiff|first6=Michael B.|last7=Jenckes|first7=Mollie W.|last8=Bass|first8=Eric B.|title=Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism: A systematic review|journal=The American Journal of Medicine|volume=117|issue=9|year=2004|pages=676–684|issn=00029343|doi=10.1016/j.amjmed.2004.04.021}}</ref> You can read more about [[diagnostic criteria]] for [[pulmonary embolism]], [[Pulmonary embolism diagnostic criteria|here]].
****Decreased breath sounds and crackles in the physical exam
*The diagnosis of [[Gastroesophageal reflux disease|GERD]] is mainly diagnosed based on the presence of [[acidic]] reflux in the [[esophagus]] through the ambulatory [[reflux]] monitoring.
**Echocardiography is the gold standard test for the diagnosis of aortic stenosis or aortic dissection.
**Diagnosis of pulmonary embolism based on signs and symptoms is difficult ,however the physician can use the Wells criteria to estimate the patient's likelihood of pulmonary embolism and accordingly further testing should be performed (e.g., d-dimer assay, ventilation-perfusion scan, helical computed tomography of the pulmonary arteries).<ref name="WellsAnderson2001">{{cite journal|last1=Wells|first1=Philip S.|last2=Anderson|first2=David R.|last3=Rodger|first3=Marc|last4=Stiell|first4=Ian|last5=Dreyer|first5=Jonathan F.|last6=Barnes|first6=David|last7=Forgie|first7=Melissa|last8=Kovacs|first8=George|last9=Ward|first9=John|last10=Kovacs|first10=Michael J.|title=Excluding Pulmonary Embolism at the Bedside without Diagnostic Imaging: Management of Patients with Suspected Pulmonary Embolism Presenting to the Emergency Department by Using a Simple Clinical Model and d-dimer|journal=Annals of Internal Medicine|volume=135|issue=2|year=2001|pages=98|issn=0003-4819|doi=10.7326/0003-4819-135-2-200107170-00010}}</ref><ref name="TamarizEng2004">{{cite journal|last1=Tamariz|first1=Leonardo J.|last2=Eng|first2=John|last3=Segal|first3=Jodi B.|last4=Krishnan|first4=Jerry A.|last5=Bolger|first5=Dennis T.|last6=Streiff|first6=Michael B.|last7=Jenckes|first7=Mollie W.|last8=Bass|first8=Eric B.|title=Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism: A systematic review|journal=The American Journal of Medicine|volume=117|issue=9|year=2004|pages=676–684|issn=00029343|doi=10.1016/j.amjmed.2004.04.021}}</ref> You can read more about diagnostic criteria for pulmonary embolism, [[Pulmonary embolism diagnostic criteria|here]].
**The diagnosis of GERD is mainly diagnosed based on the presence of acidic reflux in the esophagus through the ambulatory reflux monitoring.


==References==
==References==

Revision as of 01:39, 5 March 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview


Diagnostic Study of Choice

  • According to the suspected etiology of the chest pain:
    • There is no single diagnostic study of choice for the diagnosis of chest pain caused by acute coronary syndrome, however ECG and cardiac enzymes are the most important initial test, Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) suggest the ECG be obtained and interpreted within 10 minutes of patient presentation in the ED.[1][2][3]
      • The following result of ECG is confirmatory of Myocardial infarction in addition to the Pain described as a substernal pressure or crushing sensation radiated to the left arm, neck and/or jaw:
        • ST- T wave changes, OR
        • New LBBB, OR
        • New Q wave

References

  1. "2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (23): e663–e828. 2013. doi:10.1161/CIR.0b013e31828478ac. ISSN 0009-7322.
  2. Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE; et al. (2012). "2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 60 (7): 645–81. doi:10.1016/j.jacc.2012.06.004. PMID 22809746.
  3. Montalescot, G.; Sechtem, U.; Achenbach, S.; Andreotti, F.; Arden, C.; Budaj, A.; Bugiardini, R.; Crea, F.; Cuisset, T.; Di Mario, C.; Ferreira, J. R.; Gersh, B. J.; Gitt, A. K.; Hulot, J.-S.; Marx, N.; Opie, L. H.; Pfisterer, M.; Prescott, E.; Ruschitzka, F.; Sabate, M.; Senior, R.; Taggart, D. P.; van der Wall, E. E.; Vrints, C. J. M.; Zamorano, J. L.; Achenbach, S.; Baumgartner, H.; Bax, J. J.; Bueno, H.; Dean, V.; Deaton, C.; Erol, C.; Fagard, R.; Ferrari, R.; Hasdai, D.; Hoes, A. W.; Kirchhof, P.; Knuuti, J.; Kolh, P.; Lancellotti, P.; Linhart, A.; Nihoyannopoulos, P.; Piepoli, M. F.; Ponikowski, P.; Sirnes, P. A.; Tamargo, J. L.; Tendera, M.; Torbicki, A.; Wijns, W.; Windecker, S.; Knuuti, J.; Valgimigli, M.; Bueno, H.; Claeys, M. J.; Donner-Banzhoff, N.; Erol, C.; Frank, H.; Funck-Brentano, C.; Gaemperli, O.; Gonzalez-Juanatey, J. R.; Hamilos, M.; Hasdai, D.; Husted, S.; James, S. K.; Kervinen, K.; Kolh, P.; Kristensen, S. D.; Lancellotti, P.; Maggioni, A. P.; Piepoli, M. F.; Pries, A. R.; Romeo, F.; Ryden, L.; Simoons, M. L.; Sirnes, P. A.; Steg, P. G.; Timmis, A.; Wijns, W.; Windecker, S.; Yildirir, A.; Zamorano, J. L. (2013). "2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology". European Heart Journal. 34 (38): 2949–3003. doi:10.1093/eurheartj/eht296. ISSN 0195-668X.
  4. Tomkowski, Witold; Swedberg, Karl; Seferovic, Petar; Sabaté Tenas, Manel; Ristić, Arsen D; Pavie, Alain; Mayosi, Bongani; Maisch, Bernhard; Lionis, Christos; Klingel, Karin; Gueret, Pascal; Brucato, Antonio; Bogaert, Jan; Barón-Esquivias, Gonzalo; Badano, Luigi; Imazio, Massimo; Charron, Philippe; Adler, Yehuda; Achenbach, Stephan; Agewall, Stefan; Al-Attar, Nawwar; Angel Ferrer, Juan; Arad, Michael; Asteggiano, Riccardo; Bueno, Héctor; Caforio, Alida L P; Carerj, Scipione; Ceconi, Claudio; Evangelista, Arturo; Flachskampf, Frank; Giannakoulas, George; Gielen, Stephan; Habib, Gilbert; Kolh, Philippe; Lambrinou, Ekaterini; Lancellotti, Patrizio; Lazaros, George; Linhart, Ales; Meurin, Philippe; Nieman, Koen; Piepoli, Massimo F; Price, Susanna; Roos-Hesselink, Jolien; Roubille, François; Ruschitzka, Frank; Sagristà Sauleda, Jaume; Sousa-Uva, Miguel; Uwe Voigt, Jens; Luis Zamorano, Jose; Zamorano, Jose Luis; Aboyans, Victor; Achenbach, Stephan; Agewall, Stefan; Badimon, Lina; Barón-Esquivias, Gonzalo; Baumgartner, Helmut; Bax, Jeroen J; Bueno, Héctor; Carerj, Scipione; Dean, Veronica; Erol, Çetin; Fitzimons, Donna; Gaemperli, Oliver; Kirchhof, Paulus; Kolh, Philippe; Lancellotti, Patrizio; Lip, Gregory YH; Nihoyannopoulos, Petros; Piepoli, Massimo F; Ponikowski, Piotr; Roffi, Marco; Torbicki, Adam; Vaz Carneiro, Antonio; Windecker, Stephan; Shuka, Naltin; Sisakian, Hamayak; Mascherbauer, Julia; Isayev, Elnur; Shumavets, Vadim; Van Camp, Guy; Gatzov, Plamen; Hanzevacki, Jadranka Separovic; Moustra, Hera Heracleous; Linhart, Ales; Møller, Jacob Eifer; Aboleineen, Mohamed Wafaie; Põder, Pentti; Lehtonen, Jukka; Antov, Slobodan; Damy, Thibaud; Schieffer, Bernhard; Dimitriadis, Kyriakos; Kiss, Robert Gabor; Rafnsson, Arnar; Arad, Michael; Novo, Salvatore; Mirrakhimov, Erkin; Stradinš, Peteris; Kavoliuniene, Ausra; Codreanu, Andrei; Dingli, Philip; Vataman, Eleonora; El Hattaoui, Mustapaha; Samstad, Stein Olav; Hoffman, Piotr; Lopes, Luís Rocha; Dimulescu, Doina Ruxandra; Arutyunov, Grigory P; Pavlovic, Milan; Dúbrava, Juraj; Sauleda, Jaume Sagristà; Andersson, Bert; Müller, Hajo; Bouma, Berto J; Abaci, Adnan; Archbold, Andrew; Nesukay, Elena (2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases". European Heart Journal. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. ISSN 0195-668X.
  5. Mandell, Lionel A.; Wunderink, Richard G.; Anzueto, Antonio; Bartlett, John G.; Campbell, G. Douglas; Dean, Nathan C.; Dowell, Scott F.; File, Thomas M.; Musher, Daniel M.; Niederman, Michael S.; Torres, Antonio; Whitney, Cynthia G. (2007). "Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults". Clinical Infectious Diseases. 44 (Supplement_2): S27–S72. doi:10.1086/511159. ISSN 1537-6591.
  6. Wells, Philip S.; Anderson, David R.; Rodger, Marc; Stiell, Ian; Dreyer, Jonathan F.; Barnes, David; Forgie, Melissa; Kovacs, George; Ward, John; Kovacs, Michael J. (2001). "Excluding Pulmonary Embolism at the Bedside without Diagnostic Imaging: Management of Patients with Suspected Pulmonary Embolism Presenting to the Emergency Department by Using a Simple Clinical Model and d-dimer". Annals of Internal Medicine. 135 (2): 98. doi:10.7326/0003-4819-135-2-200107170-00010. ISSN 0003-4819.
  7. Tamariz, Leonardo J.; Eng, John; Segal, Jodi B.; Krishnan, Jerry A.; Bolger, Dennis T.; Streiff, Michael B.; Jenckes, Mollie W.; Bass, Eric B. (2004). "Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism: A systematic review". The American Journal of Medicine. 117 (9): 676–684. doi:10.1016/j.amjmed.2004.04.021. ISSN 0002-9343.