Early Evaluation of Cardiac Chest Pain – Beyond History and Electrocardiograph

Acute Coronary Syndrome (ACS) represents a continuous spectrum of disease including Unstable Angina (UA), acute non-ST elevation myocardial infarction (NSTEMI), and acute ST elevation myocardial infarction (STEMI). In spite of major advances in prevention and treatment, Acute Coronary Syndrome remains a leading cause of death as well as a major cause of hospital admissions both within Europe and worldwide.[1-3] Recent advances have allowed for early detection and disposition of patients with Acute Coronary Syndrome. The first step in the management of patients with ACS is prompt recognition. The diagnosis of ACS is largely based on the history, the electrocardiogram (ECG) and changes in cardiac biomarkers. It is a universally acknowledged fact that history remains the most essential tool in directing the need for further workup which includes serial ECGs and measurement of cardiac biomarkers. 2. Diagnostic challenges The ECG is an important diagnostic and risk stratification tool. Most patients who have UA/NSTEMI have some ECG changes, although the ECG may be normal in 1 % to 6 % of patients who have NSTEMI and in approximately 4 % of patients who have UA.[4]S