The Interdisciplinary Management of Acute Chest Pain
Raphael R Bruno1, Norbert Donner-Banzhoff, Wolfgang Söllner
1Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuernberg, Department of General Practice/Family Medicine, University of Marburg, Department of Psychosomatics and Psychotherapeutic Medicine, Paracelsus Medical University, Nuernberg, Department of Gastroenterology, Hepatology, Neurogastroenterology, Infectiology, Hematology and Oncology, HELIOS Hospital Krefeld, Department of Cardiology, University Hospital Basel, Switzerland.
Insights
Acute chest pain requires prompt evaluation to identify life-threatening causes like coronary heart disease. Early diagnosis using ECG and troponin levels is crucial for effective management and improved patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Medicine
Background:
- Acute chest pain is a frequent medical presentation with significant mortality risk.
- Coronary heart disease accounts for up to 25% of acute chest pain cases.
- Timely, goal-oriented management is essential due to potential life-threatening etiologies.
Purpose of the Study:
- To review diagnostic strategies for acute chest pain.
- To highlight key elements in the differential diagnosis of chest pain.
- To emphasize the importance of appropriate work-up and management.
Main Methods:
- Selective literature search in PubMed.
- Review of pertinent articles and clinical guidelines.
Main Results:
- Initial assessment includes history, physical examination, and 12-lead electrocardiogram (ECG).
- ST-segment elevation on ECG warrants cardiac catheterization; troponin measurements aid in diagnosing acute myocardial infarction.
- Identifying diverse causes (vascular, musculoskeletal, etc.) from history is vital for targeted treatment; elderly patients require special consideration.
Conclusions:
- Acute chest pain presents a significant diagnostic challenge.
- Diagnostic errors often stem from overlooking critical causes or inadequate work-up.
- Future research should focus on optimizing interdisciplinary patient management.
Background:
Acute chest pain of non-traumatic origin is a common reason for presentation to physician's offices and emergency rooms. Coronary heart disease is the cause in up to 25% of cases. Because acute chest pain, depending on its etiology, may be associated with a high risk of death, rapid, goal-oriented management is mandatory.
Methods:
This review is based on pertinent articles and guidelines retrieved by a selective search in PubMed.
Results:
History-taking, physical examination, and a 12-lead electrocardiogram (ECG) are the first steps in the differential diagnostic process and generally allow the identification of features signifying a high risk of lifethreatening illness. If the ECG reveals ST-segment elevation, cardiac catheterization is indicated. The timedependent measurement of highly sensitive troponin values is a reliable test for the diagnosis or exclusion of acute myocardial infarction. A wide variety of other potential causes (e.g., vascular, musculoskeletal, gastroenterologic, or psychosomatic) must be identified from the history if they are to be treated appropriately. Elderly patients need special attention.
Conclusion:
Acute chest pain is a major diagnostic challenge for the physician. Common errors are traceable to non-recognition of important causes and to an inadequate diagnostic work-up. Future studies should be designed to help optimize the interdisciplinary management of patients with chest pain.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:26Angina IV: Management
01:20Angina V: Nursing Management
01:25Pericarditis IV: Nursing Management
01:27Coronary Artery Disease V: Interprofessional Care