Chest pain diagnostic study of choice

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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]

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.
  • 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
• Chest X-ray is the gold standard test for the diagnosis of pneumothorax or pneumonia.
  • Order a chest X-ray if the patient presents with any of the following:
    • Fever (>37.8° C / 100° F)
    • Tachypnea (> 20 breaths/min)
    • Tachycardia (> 100 bpm)
    • Decreased breath sounds and crackles in the physical exam
• Echocardiography is the gold standard test for the diagnosis of aortic stenosis or aortic dissection.

• CT angiography is the gold standard test for the diagnosis of pulmonary embolism. A high-sensitivity D-dimer is useful to rule out PE only when negative in low-risk patients.
• The diagnosis of GERD is mainly diagnosed based on the presence of acidic reflux in the esophagus through the ambulatory reflux monitoring.
• Investigations:
  • Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
  • Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
  • Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.

Diagnostic Criteria

• Here you should describe the details of the diagnostic criteria.
• Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
• Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
• Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
• Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
• To view an example (endocarditis diagnostic criteria), click here
• If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
• You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
• [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
• There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].

• The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
• The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].

• [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
  • Criteria 1
  • Criteria 2
  • Criteria 3

IF there are clear, established diagnostic criteria: