Chest pain and ACS

One of our favorite question in ED is: “Does this patient with chest pain have ACS?” JAMA in Nov. 2015 tried to answer this question from the eyes of cardiologist in ED! Patient presented to ED with chest pain evaluated from 1995 to 2015. History, physical exam, ECG, clinical decision rule and Troponin were examined and they published who have more specific and higher LR of ACS.

  1. Radiation to both arms
  2. abnormal prior stress test and peripheral arterial disease
  3. Hypotension and lung rales
  4. ischemic ECG and T wave Inversion

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