Approach to undifferentiated chest pain in the emergency department: A review of recent medical literature and published practice guidelines

Mount Sinai Journal of Medicine

Volumn 73, Issue 2, 2006, Pages 499-505

  Ringstrom, Elin ^a   Freedman, Jessica ^a  

^a MOUNT SINAI SCHOOL OF MEDICINE   (United States)

Author keywords

Angina pectoris; Chest pain; Differential diagnosis; Electrocardiography; Medical history taking; Physical examination; Practice guidelines; Symptoms

Indexed keywords

ANTACID AGENT; ANTIBIOTIC AGENT; ANTITHROMBIN; ANTITHROMBOCYTIC AGENT; ANXIOLYTIC AGENT; FIBRINOLYTIC AGENT; NONSTEROID ANTIINFLAMMATORY AGENT; QUINOLINE DERIVED ANTIINFECTIVE AGENT;

ANTIBIOTIC RESISTANCE; AORTA DISSECTION; AORTA SURGERY; COMPUTER ASSISTED TOMOGRAPHY; DIAGNOSTIC ERROR; DIAGNOSTIC VALUE; DIFFERENTIAL DIAGNOSIS; ELECTROCARDIOGRAM; EMERGENCY WARD; ENZYME LINKED IMMUNOSORBENT ASSAY; ESOPHAGUS RUPTURE; GASTROINTESTINAL DISEASE; HEART MUSCLE ISCHEMIA; HUMAN; INFORMATION PROCESSING; LABORATORY DIAGNOSIS; LUNG EMBOLISM; MEDLINE; NERVE ROOT COMPRESSION; PANIC; PERICARDIOCENTESIS; PERICARDITIS; PHYSICAL EXAMINATION; PNEUMONIA; PNEUMOTHORAX; PRACTICE GUIDELINE; REVIEW; THORAX PAIN; THORAX RADIOGRAPHY; THORAX WALL DEFECT;

ACUTE DISEASE; CHEST PAIN; EMERGENCY SERVICE, HOSPITAL; EVIDENCE-BASED MEDICINE; HEART DISEASES; HUMANS; OBSERVATION; PRACTICE GUIDELINES;

EID: 33645018957     PISSN: 00272507     EISSN: 00272507     Source Type: Journal    
DOI: None     Document Type: Review

References (60)

1. Graff LG, Dallara J, Ross MA, et al. Impact on the care of the emergency department chest pain patient from the chest pain evaluation registry (CHEPER) study. Am J Cardiol 1997; 80(5):563-568.
2. Kochanek KD, Smith BL. Deaths: preliminary data for 2002. National vital statistics reports. Hyattsville, Maryland: National Center for Health Statistics, 2004:1-48.
3. Christenson J, Innes G, McKnight D, et al. Safety and efficiency of emergency department assessment of chest discomfort. CMAJ 2004; 170:1803-1807.
4. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000; 342(16):1163-1170.
5. Karcz A. Korn R, Burke MC, et al. Malpractice claims against emergency physicians in Massachusetts: 1975-1993. Am J Emerg Med 1996; 14(4):341-345.
6. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Available at: http://www.ace.org/clinical/guidelines/stemi/index.pdf. Accessed October 24, 2004.
7. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000; 283(7):897-903.
8. Bordeleau L, Cwinn A, Turek M, et al. Aortic dissection and Turner's syndrome: case report and review of the literature. J Emerg Med 1998; 16(4):593-596.
9. Klompas M. Does this patient have an acute thoracic aortic dissection? JAMA 2002; 287:2262-2272.
10. Rosman HS, Patel S, Borzak S, et al. Quality of history taking in patients with aortic dissection. Chest Pain 1998; 114(3):793-795.
11. von Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Arch Intern Med 2000; 160(19):2977-2982.
12. Cushman M, Tsai AW, White RH, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004; 117(1):19-25.
13. Kurkciyan I, Meron G, Sterz F, et al. Pulmonary embolism as cause of cardiac arrest: presentation and outcome. Arch Intern Med 2000: 160(10):1529-1535.
14. Wicki J, Preveger TV, Junod AF, et al. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med 2001; 161(1):92-97.
15. Chunilal SD. Eikelboom JW, Attia J, et al. Does this patient have pulmonary embolism? JAMA 2003; 290(21):2849-858.
16. Stein PD, Afzal A, Henry JW, Villareal CG. Fever in acute pulmonary embolism. Chest 2000; 117:39-42.
17. Stein PD, Saltzman HA, Weg JG. Clinical characteristics of patients with acute pulmonary embolism. Am J Cardiol 1991; 68(17):1723-1724.
18. American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected pulmonary embolism. Ann Emerg Med 2003; 41:257-270.
19. Brown MD, Rowe BH, Reeves MJ, et al. The accuracy of the enzyme-linked immunosorbent assay D-dimer test in the diagnosis of pulmonary embolism: a meta-analysis. Ann Emerg Med 2002; 40(2):133-144.
20. Kline JA. Nelson RD, Jackson RE, Courtney DM. Criteria for the safe use of D-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter US study. Ann Emerg Med 2002; 39(2):144-152.
21. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001; 135(2):98-107.
22. Vyas H, Desal D, Abraham P, Joshi A. Heparin therapy for mistaken cardiac diagnosis in Boerhaave's syndrome. Indian J Gastroenterol 2004; 23(2):72-73.
23. Lemke T, Jagminas L, Spontaneous esophageal rupture: a frequently missed diagnosis. Am Surg 1999; 65(5):449-452.
24. Hill AG, Tiu AT, Martin IG. Boerhaave's syndrome: 10 years experience and review of the literature. ANZ J Surg 2003: 73(12):1008-1010.
25. Liang SG, Ooka F, Santo A, Kaibara M. Pneumomediastinum following esophageal rupture associated with hyperemesis gravidarum. J Obstet Gynaecol Res 2002; 28(3):172-175.
26. Kollmar O, Lindemann W, Richter S, et al. Boerhaave's syndrome: primary repair vs. esophageal resection - case reports and meta-analysis of the literature. J Gastrointest Surg 2003; 7(6):726-734.
27. Henderson JA, Peloquin AJ. Boerhaave revisited: spontaneous esophageal perforation as a diagnostic masquerader. Am J Med 1989; 86(5):559-567.
28. Eroglu A, Kurkcuoglu IC, Karaoglanoglu N, et al, Esophageal perforation: the importance of early diagnosis and primary repair. Dis Esoph 2004; 17:91-94.
29. Baumann MH, Strange C, Heffner JE, et al; AACP Pneumothorax Consensus Group. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001; 119:590-602.
30. Imazio M, Demichelis B, Cecchi E, et al. Cardiac troponin I in acute pericarditis. J Am Coll Cardiol 2003; 42(12):2144-2148.
31. Haley JH, Tajik AJ, Danielson GK, et al. Transient constrictive pericarditis: causes and natural history. J Am Coll Cardiol 2004; 43(2):271-275.
32. Zayas R, Anguita M, Torres F, et al. Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol 1995; 75(5):378-382.
33. Tsang TS, Barnes ME, Gersh BJ, et al. Outcomes of clinically significant idiopathic pericardial effusion requiring intervention. Am J Cardiol 2003; 91(6):704-707.
34. Maisch B, Seferovic PM, Ristic AD, et al.; Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology. Guidelines on the diagnosis and management of pericardial diseases. Executive summary; the task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology. Fur Heart J 2004; 25(7):587-610.
35. Bruch C, Schmermund A, Dagres N, et al. Changes in QRS voltage in cardiac tamponade and pericardial effusion: reversibility after pericardiocentesis and after anti-inflammatory drug treatment. J Am Coll Cardiol 2001; 38(1):219-226.
36. Bonnefoy E, Gordon P, Kirkorian G, et al. Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur Heart J 2000; 21(10):832-836.
37. Fine MJ, Stone RA, Lave JR, Hough LJ, et al. Implementation of an evidence-based guideline to reduce duration of intravenous antibiotic therapy and length of stay for patients hospitalized with community-acquired pneumonia: a randomized controlled trial. Am J Med 2003; 115(5):343-351.
38. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336(4):243-250.
39. American College of Emergency Physicians. Clinical policy for the management and risk stratification of community-acquired pneumonia in adults in the emergency department. Ann Emerg Med 2001; 38:107-113.
40. Bjerre LM, Verheij TJ, Kochen MM. Antibiotics for community acquired pneumonia in adult outpatients. Cochrane Database Syst Rev 2004; 4:1-25; 2004;(2):CD002109.
41. Chen DK, McGreer A, de Azavedo JC, Low DE. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. Canadian Bacterial Surveillance Network. N Engl J Med 1999; 341(4):233-239.
42. Davidson R, Cavaleant R, Brunton JL, et al. Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia. N Engl J Med 2002; 346(10):747-750.
43. Houck PM, Bratzler DW, Nsa W, et al. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004; 164(6):637-644.
44. Silber SH, Garnett C, Singh R, et al. Early administration of antibiotics does not shorten time to clinical stability in patients with moderate-to-severe community-acquired pneumonia. Chest 2003; 124(5):1798-1804.
45. Chun AA McGee SR. Bedside diagnosis of coronary artery disease: a systematic disease. Am J Med 2004; 117(5):334-343.
46. Rief W, Nanke A, Klaiberg A, Braehler E. Best rates for panic and depression according to the Brief Patient Health Questionnaire: a population-based study. J Affect Disord 2004; 82(2):271-276.
47. Goodwin R. The prevalence of panic attacks in the United States: 1980 to 1995. J Clin Epidemiol 2003; 56:914-916.
48. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association, 1994.
49. Fleet RP, Dupuis G, Marchand A, et al. Panic disorder in emergency department chest pain patients: prevalence comorbidity, suicidal ideation, and physician recognition. Am J Med 1996; 101(4):371-380.
50. Yingling KW, Wulsin LB, Arnold LM, Rouan GW. Estimated prevalences of panic disorder and depression among consecutive patients seen in an emergency department with acute chest pain. J Gen Intern Med 1993; 8(5):231-235.
51. Katerndahl D. Panic plaques: panic disorder & coronary artery disease in patients with chest pain. J Am Board Fam Pract 2004: 17:114-126.
52. Dammen T, Arnesen H, Ekeberg O, Friis S. Psychological factors, pain attribution and medical morbidity in chest-pain patients with and without coronary artery disease. Gen Hosp Psychiatry 2004; 26(4):463-469.
53. Huffman JC, Pollack MH, Predicting panic disorder among patients with chest pain: an analysis of the literature. Psychosomatics 2003; 44(3):222-236.
54. Wulsin L, Liu T, Storrow A, et al. A randomized, controlled trial of panic disorder treatment initiation in an emergency department chest pain center. Ann Emerg Med 2002; 39(2):139-143.
55. Fruergaard P, Launbjerg J, Hesse B, et al. The diagnoses of patients admitted with acute chest pain but without myocardial infarction. Eur Heart J 1996; 17(7):1028-1034.
56. Goodacre S, Locker T, Morris F, Campbell S. How useful are clinical features in the diagnosis of acute, undifferentiated chest pain? Acad Emerg Med 2002;9(3):203-208.
57. Goodacre S, Angelini K, Arnold J, et al. Clinical predictors of acute coronary syndromes in patients with undifferentiated chest pain. OJM 2003; 96(12):893-898.
58. Dobrzycki S, Baniukiewicz A, Korecki J, et al. Does gastroesophageal reflux provoke the myocardial ischemia in patients with CAD? Int J Cardiol 2005; 104:67-72.
59. Shry EA, Dacus J, Van De Graaff E, et al. Usefulness of the response to sublingual nitroglycerin as a predictor of ischemic chest pain in the emergency department. Am J Cardiol 2002; 90(1):1264-1266.
60. Panju AA, Hemmelgarn BR, Guyatt GIL Simel DL. The rational clinical examination. Is this patient having a myocardial infarction? JAMA 1998; 280(14):1256-1263.