Chest pain diagnostic study of choice: Difference between revisions
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==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
*According to the suspected etiology of the chest pain: | *'''According to the suspected etiology of the chest pain:''' | ||
*There is no single diagnostic study of choice for the diagnosis of chest pain caused by acute coronary syndrome, however ECG and cardiac enzymes are the ''most important initial test'', Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) suggest the ECG be obtained and interpreted within 10 minutes of patient presentation in the ED. | **There is no single diagnostic study of choice for the diagnosis of chest pain caused by acute coronary syndrome, however ECG and cardiac enzymes are the ''most important initial test'', Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) suggest the ECG be obtained and interpreted within 10 minutes of patient presentation in the ED. | ||
**The following result of '''ECG''' is confirmatory of '''Myocardial infarction''' in addition to the Pain described as a substernal pressure or crushing sensation radiated to the left arm, neck and/or jaw: | ***The following result of '''ECG''' is confirmatory of '''Myocardial infarction''' in addition to the Pain described as a substernal pressure or crushing sensation radiated to the left arm, neck and/or jaw: | ||
***ST- T wave changes, '''''OR''''' | ****ST- T wave changes, '''''OR''''' | ||
***New LBBB, '''''OR''''' | ****New LBBB, '''''OR''''' | ||
***New Q wave | ****New Q wave | ||
*Chest X-ray is the gold standard test for the diagnosis of pneumothorax or pneumonia. | **Chest X-ray is the gold standard test for the diagnosis of pneumothorax or pneumonia. You can read more about diagnostic criteria for severe community acquired pneumonia in adults, [[Pneumonia diagnostic criteria|here]]. | ||
**Order a chest X-ray if the patient presents with any of the following: | ***Order a chest X-ray if the patient presents with any of the following: | ||
***Fever (>37.8° C / 100° F) | ****Fever (>37.8° C / 100° F) | ||
***Tachypnea (> 20 breaths/min) | ****Tachypnea (> 20 breaths/min) | ||
***Tachycardia (> 100 bpm) | ****Tachycardia (> 100 bpm) | ||
***Decreased breath sounds and crackles in the physical exam | ****Decreased breath sounds and crackles in the physical exam | ||
*Echocardiography is the gold standard test for the diagnosis of aortic stenosis or aortic dissection. | **Echocardiography is the gold standard test for the diagnosis of aortic stenosis or aortic dissection. | ||
*Diagnosis of pulmonary embolism based on signs and symptoms is difficult ,however the physician can use the Wells criteria to estimate the patient's likelihood of pulmonary embolism and accordingly further testing should be performed (e.g., d-dimer assay, ventilation-perfusion scan, helical computed tomography of the pulmonary arteries). | **Diagnosis of pulmonary embolism based on signs and symptoms is difficult ,however the physician can use the Wells criteria to estimate the patient's likelihood of pulmonary embolism and accordingly further testing should be performed (e.g., d-dimer assay, ventilation-perfusion scan, helical computed tomography of the pulmonary arteries). You can read more about diagnostic criteria for pulmonary embolism, [[Pulmonary embolism diagnostic criteria|here]]. | ||
*The diagnosis of GERD is mainly diagnosed based on the presence of acidic reflux in the esophagus through the ambulatory reflux monitoring. | **The diagnosis of GERD is mainly diagnosed based on the presence of acidic reflux in the esophagus through the ambulatory reflux monitoring. | ||
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[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]
Overview
Diagnostic Study of Choice
- According to the suspected etiology of the chest pain:
- There is no single diagnostic study of choice for the diagnosis of chest pain caused by acute coronary syndrome, however ECG and cardiac enzymes are the most important initial test, Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) suggest the ECG be obtained and interpreted within 10 minutes of patient presentation in the ED.
- The following result of ECG is confirmatory of Myocardial infarction in addition to the Pain described as a substernal pressure or crushing sensation radiated to the left arm, neck and/or jaw:
- ST- T wave changes, OR
- New LBBB, OR
- New Q wave
- The following result of ECG is confirmatory of Myocardial infarction in addition to the Pain described as a substernal pressure or crushing sensation radiated to the left arm, neck and/or jaw:
- Chest X-ray is the gold standard test for the diagnosis of pneumothorax or pneumonia. You can read more about diagnostic criteria for severe community acquired pneumonia in adults, here.
- Order a chest X-ray if the patient presents with any of the following:
- Fever (>37.8° C / 100° F)
- Tachypnea (> 20 breaths/min)
- Tachycardia (> 100 bpm)
- Decreased breath sounds and crackles in the physical exam
- Order a chest X-ray if the patient presents with any of the following:
- Echocardiography is the gold standard test for the diagnosis of aortic stenosis or aortic dissection.
- There is no single diagnostic study of choice for the diagnosis of chest pain caused by acute coronary syndrome, however ECG and cardiac enzymes are the most important initial test, Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) suggest the ECG be obtained and interpreted within 10 minutes of patient presentation in the ED.
- Diagnosis of pulmonary embolism based on signs and symptoms is difficult ,however the physician can use the Wells criteria to estimate the patient's likelihood of pulmonary embolism and accordingly further testing should be performed (e.g., d-dimer assay, ventilation-perfusion scan, helical computed tomography of the pulmonary arteries). You can read more about diagnostic criteria for pulmonary embolism, here.
- The diagnosis of GERD is mainly diagnosed based on the presence of acidic reflux in the esophagus through the ambulatory reflux monitoring.