Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes
Clifford J Swap1, John T Nagurney
1Massachusetts General Hospital, Boston, MA 02114, USA.
JAMA
|November 24, 2005
Summary
Certain chest pain features can suggest or rule out acute coronary syndrome (ACS). However, chest pain history alone is insufficient for diagnosis, necessitating further testing for all patients.
Area of Science:
- Cardiology
- Clinical Diagnostics
- Medical Decision Making
Background:
- Initial assessment of chest pain relies on history, physical exam, risk factors, and ECG to estimate acute myocardial infarction (AMI) or acute coronary syndrome (ACS) probability.
- Conflicting evidence exists regarding the diagnostic utility of chest pain history and its specific components.
Purpose of the Study:
- To determine which elements of a patient's chest pain history are most valuable for clinicians in diagnosing ACS.
Main Methods:
- A systematic literature search was conducted using MEDLINE and Ovid databases (1970-2005).
- Keywords and Medical Subject Headings were employed, supplemented by reference lists and cardiology textbooks.
Main Results:
- Stabbing, pleuritic, positional, or reproducible chest pain decreases ACS likelihood (LRs 0.2-0.3).
- Exertional chest pain or radiation to shoulders/arms increases ACS likelihood (LRs 2.3-4.7).
- Chest pain history alone is not a definitive diagnostic tool, and further testing is generally required.
Conclusions:
- While specific chest pain characteristics influence ACS/AMI likelihood, no single feature or combination reliably identifies patients safe for discharge without further evaluation.
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