[Management of first transient chest pain]

Unstable angina is the first diagnosis to consider in a patient with transient chest pain; if managed in the setting of a coronary care unit, this condition leads to myocardial infarction in less than 5% of patients. Conversely half of acute myocardial infarctions have been heralded by unrecognised unstable anginal; thus a good proportion of the 120,000 infarctions occurring yearly in France could be avoided. Pre-hospital diagnosis is based on chest pain characterisation since physical examination and electrocardiogram are usually normal when the patient is pain free. The major concern being to avoid underdiagnosis, sensitivity is in this setting more important than specificity the patient should be hospitalised whenever a reasonable doubt exists.