• Dtsch Arztebl Int · Nov 2015

    Review

    The Interdisciplinary Management of Acute Chest Pain.

    • Raphael R Bruno, Norbert Donner-Banzhoff, Wolfgang Söllner, Thomas Frieling, Christian Müller, and Michael Christ.
    • Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuernberg, Department of General Practice/Family Medicine, University of Marburg, Department of Psychosomatics and Psychotherapeutic Medicine, Paracelsus Medical University, Nuernberg, Department of Gastroenterology, Hepatology, Neurogastroenterology, Infectiology, Hematology and Oncology, HELIOS Hospital Krefeld, Department of Cardiology, University Hospital Basel, Switzerland.
    • Dtsch Arztebl Int. 2015 Nov 6; 112 (45): 768780768-79; quiz 780.

    BackgroundAcute chest pain of non-traumatic origin is a common reason for presentation to physician's offices and emergency rooms. Coronary heart disease is the cause in up to 25% of cases. Because acute chest pain, depending on its etiology, may be associated with a high risk of death, rapid, goal-oriented management is mandatory.MethodsThis review is based on pertinent articles and guidelines retrieved by a selective search in PubMed.ResultsHistory-taking, physical examination, and a 12-lead electrocardiogram (ECG) are the first steps in the differential diagnostic process and generally allow the identification of features signifying a high risk of lifethreatening illness. If the ECG reveals ST-segment elevation, cardiac catheterization is indicated. The timedependent measurement of highly sensitive troponin values is a reliable test for the diagnosis or exclusion of acute myocardial infarction. A wide variety of other potential causes (e.g., vascular, musculoskeletal, gastroenterologic, or psychosomatic) must be identified from the history if they are to be treated appropriately. Elderly patients need special attention.ConclusionAcute chest pain is a major diagnostic challenge for the physician. Common errors are traceable to non-recognition of important causes and to an inadequate diagnostic work-up. Future studies should be designed to help optimize the interdisciplinary management of patients with chest pain.

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