RT Journal Article
SR Electronic
T1 Evaluating patients with chest pain in the emergency department
JF BMJ
JO BMJ
FD British Medical Journal Publishing Group
SP r136
DO 10.1136/bmj.r136
VO 388
A1 Bellolio, Fernanda
A1 Gottlieb, Michael
A1 Body, Richard
A1 Than, Martin P
A1 Hess, Erik P
YR 2025
UL https://www.bmj.com/content/388/bmj.r136.abstract
AB Identifying patients with chest pain that is of cardiac origin is crucial owing to the high mortality and morbidity of cardiovascular diseases. History, electrocardiogram, and cardiac biomarkers are the core elements of the assessment. High sensitivity cardiac troponins (hs-cTn) are the preferred biomarkers for diagnosing acute myocardial infarction, allowing for more accurate detection and exclusion of myocardial injury. However, elevations in hs-cTn can occur in patients who are not experiencing acute myocardial infarction. Therefore, it is important for clinicians to recognize how to integrate hs-cTn levels into their clinical decision making process. Structured risk assessments, using evidence based diagnostic protocols, should be employed to estimate the risk of acute coronary syndrome and adverse events in patients with chest pain. Clinical decision pathways should be used routinely in emergency departments. Patients at intermediate or high risk of obstructive coronary artery disease might benefit from cardiac imaging and further testing. Patients should be involved in decision making, with information provided about risks, radiation exposure, costs, and alternative options to facilitate informed decision making.