Managing Acute Chest Pain

Asma Kazi

doi:10.70302/jpsim.v5i1.2402

Review Article

Managing Acute Chest Pain

Asma Kazi

Professor of Medicine, Rashid Latif Medical College, Lahore

✉ Correspondence: Asma Kazi Email: docasmakazi@gmail.com

DOI https://doi.org/10.70302/jpsim.v5i1.2402

Volume: 5, Issue 1 (Women Issue) Pages: 365–369 Published: 28 Feb 2024

Received: 22 Sep 2023 Accepted: 27 Nov 2023 Published Online: 28 Feb 2024

Abstract

Acute chest pain is a common and potentially life-threatening symptom that requires prompt evaluation and management. It can be caused by a wide range of conditions, from benign musculoskeletal issues to serious cardiac events. Effective management of acute chest pain involves a systematic approach that prioritizes the identification and treatment of life-threatening causes while also considering the possibility of non-cardiac etiologies. This guideline provides a comprehensive overview of the evaluation and management of acute chest pain.

How to Cite This Article

Kazi A. Managing Acute Chest Pain. J Pak Soc Intern Med. 2024;5(1):365–369. doi:10.70302/jpsim.v5i1.2402

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Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

References

Jänig W. Neurobiology of visceral pain. Schmerz. 2014;28(3):233-51.
Fruergaard P, Launbjerg J, Hesse B, Jørgensen F, Petri A, Eiken P et al. The diagnoses of patients admitted with acute chest pain but without myocardial infarction. Eur Heart J. 1996;17(7):1028-34.
Achenbach S, Marwan M, Ropers D. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J. 2010; 31(3): 340-6.
Lee TH, Goldman L. Evaluation of the patient with acute chest pain. N Engl J Med. 2000; 342(6): 1187-95.
Forest RS, Shofer FS, Sease KL. Assessment of the standardized reporting guidelines ECG classification system: the presenting ECG predicts 30-day outcomes. Ann Emerg Med. 2004; 44(2): 206-12.
Kontos MC, Roberts BD, Tatum JL, et al. Mortality based on the presenting electrocardiogram in patients with myocardial infarction in the troponin era. Am J Emerg Med. 2009; 27(1): 146-52.
Kontos MC, Diercks DB, Kirk JD. Emergency department and office-based evaluation of patients with chest pain. Mayo Clin Proc. 2010; 85(2): 284-99.
Knowlman T, Greenslade JH, Parsonage W, Hawkins T, Ruane L, Martin P et al. The association of electrocardiographic abnormalities and acute coronary syndrome in emergency patients with chest pain. Acad Emerg Med. 2017; 24(3): 344-52.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the Management of Acute Myocardial Infarction in Patients Presenting with ST-segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119-77.
Stepinska J, Lettino M, Ahrens I. Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association. Eur Heart J. 2020;9(1):76-89.
Buenger RE. Five thousand acute care/emergency department chest radiographs: comparison of requisitions with radiographic findings. J Emerg Med. 1988; 6(3): 197–202.
Roffi M, Patrono C, Collet J-P, Mueller C, Valgimigli M, Andreotti F et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Polish Heart J. 2015;73(12):1207-94.
13.Ferencik M, Hoffmann U, Bamberg F, Januzzi JL. Highly sensitive troponin and coronary computed tomography angiography in the evaluation of suspected acute coronary syndrome in the emergency department. Eur Heart J. 2016; 37(30): 2397-405.
Twerenbold R, Boeddinghaus J, Nestelberger T, Wildi K, Rubini Gimenez M, Badertscher P et al. Clinical use of high-sensitivity cardiac troponin in patients with suspected myocardial infarction. J Am Coll Cardiol. 2017; 70(8): 996-1012.
Möckel M, Giannitsis E, Mueller C, Huber K, Jaffe AS, Mair J et al. Rule-in of acute myocardial infarction: focus on troponin. Eur Heart J Acute Cardiovasc Care. 2017; 6(3): 212-17.
Keller T, Zeller T, Peetz D, Tzikas S, Roth A, Czyz E et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 2009; 361(9): 868-77.
Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult: the Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(12): 2873-926.
Gallagher MJ, Raff GL. Use of multislice CT for the evaluation of emergency room patients with chest pain: the so-called “Triple rule-out”. Catheter Cardiovasc Interv. 2008; 71(1): 92-9.
Lancellotti P, Price S, Edvardsen T, Cosyns B, Neskovic AN, Dulgheru R et al. The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Image. 2015; 16(2):119-46.
Akyea RK, Leonardi-Bee J, Asselbergs FW, Patel RS, Durrington P, Wierzbicki AS et al. Predicting major adverse cardiovascular events for secondary prevention: protocol for a systematic review and meta-analysis of risk prediction models. BMJ Open. 2020;10(7):e034564.
Antwi-Amoabeng D, Roongsritong C, Taha M, Beutler BD, Awad M, Hanfy A et al. SVEAT score outperforms HEART score in patients admitted to a chest pain observation unit. World J Cardiol. 2022;14(8):454-61.
Antwi-Amoabeng D, Roongsritong C, Taha M, Beutler BD, Awad M, Hanfy A et al. SVEAT score outperforms HEART score in patients admitted to a chest pain observation unit. World J Cardiol. 2022;14(8):454-61.
Roongsritong C, Taha ME, Pisipati S, Aung S, Latt H, Thomas J et al. SVEAT score, a potential new and improved tool for acute chest pain risk stratification. Am J Cardiol. 2020;127(1):36-40.S
Amsterdam EA, Kirk JD, Bluemke DA, Diercks D, Farkouh ME, Garvey JL et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation. 2010; 122(17): 1756-76.
Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR et al. 2014 AHA/ACC Guideline for the management of patients with non-ST-elevation acute coronary syndromes. J Am Coll Cardiol. 2014; 64(24): e139-e228.

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2024 Journal of Pakistan Society of Internal Medicine.

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[1] Jänig W. Neurobiology of visceral pain. Schmerz. 2014;28(3):233-51.

[2] Fruergaard P, Launbjerg J, Hesse B, Jørgensen F, Petri A, Eiken P et al. The diagnoses of patients admitted with acute chest pain but without myocardial infarction. Eur Heart J. 1996;17(7):1028-34.

[3] Achenbach S, Marwan M, Ropers D. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J. 2010; 31(3): 340-6.

[4] Lee TH, Goldman L. Evaluation of the patient with acute chest pain. N Engl J Med. 2000; 342(6): 1187-95.

[5] Forest RS, Shofer FS, Sease KL. Assessment of the standardized reporting guidelines ECG classification system: the presenting ECG predicts 30-day outcomes. Ann Emerg Med. 2004; 44(2): 206-12.

[6] Kontos MC, Roberts BD, Tatum JL, et al. Mortality based on the presenting electrocardiogram in patients with myocardial infarction in the troponin era. Am J Emerg Med. 2009; 27(1): 146-52.

[7] Kontos MC, Diercks DB, Kirk JD. Emergency department and office-based evaluation of patients with chest pain. Mayo Clin Proc. 2010; 85(2): 284-99.

[8] Knowlman T, Greenslade JH, Parsonage W, Hawkins T, Ruane L, Martin P et al. The association of electrocardiographic abnormalities and acute coronary syndrome in emergency patients with chest pain. Acad Emerg Med. 2017; 24(3): 344-52.

[9] Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the Management of Acute Myocardial Infarction in Patients Presenting with ST-segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119-77.

[10] Stepinska J, Lettino M, Ahrens I. Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association. Eur Heart J. 2020;9(1):76-89.

[11] Buenger RE. Five thousand acute care/emergency department chest radiographs: comparison of requisitions with radiographic findings. J Emerg Med. 1988; 6(3): 197–202.

[12] Roffi M, Patrono C, Collet J-P, Mueller C, Valgimigli M, Andreotti F et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Polish Heart J. 2015;73(12):1207-94.

[13] 13.Ferencik M, Hoffmann U, Bamberg F, Januzzi JL. Highly sensitive troponin and coronary computed tomography angiography in the evaluation of suspected acute coronary syndrome in the emergency department. Eur Heart J. 2016; 37(30): 2397-405.

[14] Twerenbold R, Boeddinghaus J, Nestelberger T, Wildi K, Rubini Gimenez M, Badertscher P et al. Clinical use of high-sensitivity cardiac troponin in patients with suspected myocardial infarction. J Am Coll Cardiol. 2017; 70(8): 996-1012.

[15] Möckel M, Giannitsis E, Mueller C, Huber K, Jaffe AS, Mair J et al. Rule-in of acute myocardial infarction: focus on troponin. Eur Heart J Acute Cardiovasc Care. 2017; 6(3): 212-17.

[16] Keller T, Zeller T, Peetz D, Tzikas S, Roth A, Czyz E et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 2009; 361(9): 868-77.

[17] Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult: the Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(12): 2873-926.

[18] Gallagher MJ, Raff GL. Use of multislice CT for the evaluation of emergency room patients with chest pain: the so-called “Triple rule-out”. Catheter Cardiovasc Interv. 2008; 71(1): 92-9.

[19] Lancellotti P, Price S, Edvardsen T, Cosyns B, Neskovic AN, Dulgheru R et al. The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Image. 2015; 16(2):119-46.

[20] Akyea RK, Leonardi-Bee J, Asselbergs FW, Patel RS, Durrington P, Wierzbicki AS et al. Predicting major adverse cardiovascular events for secondary prevention: protocol for a systematic review and meta-analysis of risk prediction models. BMJ Open. 2020;10(7):e034564.

[21] Antwi-Amoabeng D, Roongsritong C, Taha M, Beutler BD, Awad M, Hanfy A et al. SVEAT score outperforms HEART score in patients admitted to a chest pain observation unit. World J Cardiol. 2022;14(8):454-61.

[22] Antwi-Amoabeng D, Roongsritong C, Taha M, Beutler BD, Awad M, Hanfy A et al. SVEAT score outperforms HEART score in patients admitted to a chest pain observation unit. World J Cardiol. 2022;14(8):454-61.

[23] Roongsritong C, Taha ME, Pisipati S, Aung S, Latt H, Thomas J et al. SVEAT score, a potential new and improved tool for acute chest pain risk stratification. Am J Cardiol. 2020;127(1):36-40.S

[24] Amsterdam EA, Kirk JD, Bluemke DA, Diercks D, Farkouh ME, Garvey JL et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation. 2010; 122(17): 1756-76.

[25] Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR et al. 2014 AHA/ACC Guideline for the management of patients with non-ST-elevation acute coronary syndromes. J Am Coll Cardiol. 2014; 64(24): e139-e228.