Evaluation of chest pain

Diseases

Summary

Chest pain is a common chief complaint, accounting for approximately 5.6% of all emergency department visits in the US per year.[1] It is the presenting complaint in approximately 0.5% of office-based visits.[2]

Chest pain may be caused by either benign or life-threatening etiologies, and is usually divided into cardiac and noncardiac causes.

Acute coronary syndrome (ACS; encompassing unstable angina, ST-elevation myocardial infarction, and non-ST-elevation myocardial infarction) may not be the most common etiology in patients presenting with chest pain. Excluding ACS is, however, vital because of the mortality associated with untreated myocardial infarction.

This topic concentrates on the evaluation of acute chest pain in the emergency setting.

Library

Distribution of final diagnoses in people over 35 years admitted to the hospital from one US hospital emergency department with chief complaint of nontraumatic chest pain, over a 5-year period (PE, pulmonary embolism)
Varicella zoster virus
ECG showing changes of an acute inferior myocardial infarction with ST elevation in leads II, III, and aVF
ECG showing ST depression
Chest x-ray showing a widened mediastinum
Chest x-ray showing a large globular heart in a patient with pericardial tamponade
Angiogram showing occluded right artery
Composition of the HEART score for chest pain patients in the emergency department
Spiral computed tomography pulmonary angiogram showing a large filling defect within the pulmonary vasculature compatible with a saddle embolus

Citations

Key Articles

Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2021 Nov 30;144(22):e368-454.[Abstract][Full Text]
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. circulation. 2014 Dec 23;130(25):e344-426.[Abstract][Full Text]
National Institute for Health and Care Excellence. Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis. Nov 2016 [internet publication].[Full Text]
O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Jan 29;127(4):e362-425.[Abstract][Full Text]
Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56.[Abstract][Full Text]

Referenced Articles

1. Cairns C, Kang K. National hospital ambulatory medical care survey: 2021 emergency department summary tables. 2021 [internet publication].[Full Text]
2. Centers for Disease Control and Prevention. National Center for Health Statistics: survey results and products - 2019 national ambulatory medical care survey summary tables. Aug 2023 [internet publication].[Full Text]
3. Kohn MA, Kwan E, Gupta M, et al. Prevalence of acute myocardial infarction and other serious diagnoses in patients presenting to an urban emergency department with chest pain. J Emerg Med. 2005 Nov;29(4):383-90.[Abstract]
4. Lindskou TA, Andersen PJ, Christensen EF, et al. More emergency patients presenting with chest pain. PLoS One. 2023 Mar 23;18(3):e0283454.[Abstract][Full Text]
5. Bjørnsen LP, Naess-Pleym LE, Dale J, et al. Description of chest pain patients in a Norwegian emergency department. Scand Cardiovasc J. 2019 Feb;53(1):28-34.[Abstract][Full Text]
6. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000 Apr 20;342(16):1163-70.[Abstract][Full Text]
7. Collinson PO, Premachandram S, Hashemi K. Prospective audit of incidence of prognostically important myocardial damage in patients discharged from emergency department. BMJ. 2000 Jun 24;320(7251):1702-5.[Abstract][Full Text]
8. Aldous SJ, Richards M, Cullen L, et al. A 2-hour thrombolysis in myocardial infarction score outperforms other risk stratification tools in patients presenting with possible acute coronary syndromes: comparison of chest pain risk stratification tools. Am Heart J. 2012 Oct;164(4):516-23.[Abstract]
9. Bader AS, Rubinowitz AN, Gange CP Jr, et al. Imaging in the evaluation of chest pain in the primary care setting, part 2: sources of noncardiac chest pain. Am J Med. 2020 Oct;133(10):1135-42.[Abstract][Full Text]
10. Haasenritter J, Biroga T, Keunecke C, et al. Causes of chest pain in primary care--a systematic review and meta-analysis. Croat Med J. 2015 Oct;56(5):422-30.[Abstract][Full Text]
11. Hoorweg BB, Willemsen RT, Cleef LE, et al. Frequency of chest pain in primary care, diagnostic tests performed and final diagnoses. Heart. 2017 Nov;103(21):1727-32.[Abstract]
12. Jordan KP, Timmis A, Croft P, et al. Prognosis of undiagnosed chest pain: linked electronic health record cohort study. BMJ. 2017 Apr 3;357:j1194.[Abstract][Full Text]
13. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2021 Nov 30;144(22):e368-454.[Abstract][Full Text]
14. Resuscitation Council UK. Adult advanced life support Guidelines. 2021 [internet publication].[Abstract][Full Text]
15. Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-468.[Full Text]
16. Berg KM, Bray JE, Ng KC, et al. 2023 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Resuscitation. 2024 Feb;195:109992.[Abstract][Full Text]
17. Chu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 2018 Apr 26;391(10131):1693-705.[Abstract]
18. Siemieniuk RAC, Chu DK, Kim LH, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018 Oct 24;363:k4169.[Abstract][Full Text]
19. Sepehrvand N, James SK, Stub D, et al. Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials. Heart. 2018 Oct;104(20):1691-8.[Abstract]
20. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. circulation. 2014 Dec 23;130(25):e344-426.[Abstract][Full Text]
21. National Institute for Health and Care Excellence. Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis. Nov 2016 [internet publication].[Full Text]
22. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Jan 29;127(4):e362-425.[Abstract][Full Text]
23. Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119-77.[Abstract][Full Text]
24. O'Driscoll BR, Howard LS, Earis J, et al; British Thoracic Society Emergency Oxygen Guideline Group; BTS Emergency Oxygen Guideline Development Group. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017 Jun;72(suppl 1):ii1-90.[Abstract][Full Text]
25. Writing Committee, Kontos MC, de Lemos JA, et al. 2022 ACC expert consensus decision pathway on the evaluation and disposition of acute chest pain in the emergency department: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022 Nov 15;80(20):1925-60.[Abstract][Full Text]
26. National Institute for Health and Care Excellence. Acute coronary syndromes. Nov 2020 [internet publication].[Full Text]
27. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc Care. 2024 Feb 9;13(1):55-161.[Full Text]
28. Bhatt DL, Lopes RD, Harrington RA. Diagnosis and treatment of acute coronary syndromes: a review. JAMA. 2022 Feb 15;327(7):662-75.
29. Kim ESH. Spontaneous Coronary-Artery Dissection. N Engl J Med. 2020 Dec 10;383(24):2358-70.
30. Faden MS, Bottega N, Benjamin A, et al. A nationwide evaluation of spontaneous coronary artery dissection in pregnancy and the puerperium. Heart. 2016 Dec 15;102(24):1974-9.[Abstract]
31. Smilowitz NR, Gupta N, Guo Y, et al. Acute myocardial infarction during pregnancy and the puerperium in the United States. Mayo Clin Proc. 2018 Oct;93(10):1404-14.[Abstract][Full Text]
32. Adlam D, Alfonso F, Maas A, et al. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018 Sep 21;39(36):3353-68.[Full Text]
33. Hayes SN, Kim ESH, Saw J, et al. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 2018 May 8;137(19):e523-57.[Abstract][Full Text]
34. Saw J, Humphries K, Aymong E, et al. Spontaneous coronary artery dissection: clinical outcomes and risk of recurrence. J Am Coll Cardiol. 2017 Aug 29;70(9):1148-58.[Abstract][Full Text]
35. Johnson AK, Tweet MS, Rouleau SG, et al. The presentation of spontaneous coronary artery dissection in the emergency department: signs and symptoms in an unsuspecting population. Acad Emerg Med. 2022 Apr;29(4):423-8.[Abstract][Full Text]
36. Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Dec 13;146(24):e334-482.[Abstract][Full Text]
37. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015 Feb 6;385(9970):800-11.[Abstract]
38. National Patient Safety Agency. Alert: Blood control safety cannula and needle thoracostomy for tension pneumothorax. April 2020 [internet publication].[Full Text]
39. Leigh-Smith S, Harris T. Tension pneumothorax - time for a re-think? Emerg Med J. 2005 Jan;22(1):8-16. [Abstract][Full Text]
40. Jones R, Hollingsworth J. Tension pneumothoraces not responding to needle thoracocentesis. Emerg Med J. 2002 Mar;19(2):176-7.[Abstract][Full Text]
41. Expert Panel on Cardiac Imaging, Kirsch J, Wu CC, et al. ACR appropriateness criteria® suspected pulmonary embolism: 2022 update. J Am Coll Radiol. 2022 Nov;19(11s):S488-501.[Abstract][Full Text]
42. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019 Oct 9;54(3):1901647.[Abstract][Full Text]
43. Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients' probability of pulmonary embolism: increasing the model's utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20.[Abstract]
44. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006 Feb 7;144(3):165-71.[Abstract]
45. Honasoge AP, Dubbs SB. Rapid fire: pericardial effusion and tamponade. Emerg Med Clin North Am. 2018 Aug;36(3):557-65.[Abstract]
46. Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA. 2005 Nov 23;294(20):2623-9.[Abstract][Full Text]
47. Carlton EW, Than M, Cullen L, et al. 'Chest pain typicality' in suspected acute coronary syndromes and the impact of clinical experience. Am J Med. 2015 Oct;128(10):1109-16.e2.[Abstract][Full Text]
48. Fanaroff AC, Rymer JA, Goldstein SA, et al. Does this patient with chest pain have acute coronary syndrome? The rational clinical examination systematic review. JAMA. 2015 Nov 10;314(18):1955-65.[Abstract]
49. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56.[Abstract][Full Text]
50. Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014 Aug 12;349:g4859. [Abstract]
51. Brieger D, Eagle KA, Goodman SG, et al; GRACE Investigators. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events. Chest. 2004 Aug;126(2):461-9.[Abstract]
52. Rich MW. Epidemiology, clinical features, and prognosis of acute myocardial infarction in the elderly. Am J Geriatr Cardiol. 2006 Jan-Feb;15(1):7-11; quiz 12.[Abstract]
53. Bayer AJ, Chadha JS, Farag PR, et al. Changing presentation of myocardial infarction with increasing old age. J Am Geriatr Soc. 1986 Apr;34(4):263-6.[Abstract]
54. Jacoby RM, Nesto RW. Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis. J Am Coll Cardiol. 1992 Sep;20(3):736-44.[Abstract][Full Text]
55. McSweeney JC, Cody M, O'Sullivan P, et al. Women's early warning symptoms of acute myocardial infarction. Circulation. 2003 Nov 25;108(21):2619-23. [Abstract][Full Text]
56. DeVon HA, Pettey CM, Vuckovic KM, et al. A review of the literature on cardiac symptoms in older and younger women. J Obstet Gynecol Neonatal Nurs. 2016 May-Jun;45(3):426-37.[Abstract]
57. Sörensen NA, Neumann JT, Ojeda F, et al. Relations of sex to diagnosis and outcomes in acute coronary syndrome. J Am Heart Assoc. 2018 Mar 10;7(6):e007297.[Abstract][Full Text]
58. National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III): final report. Circulation. 2002 Dec 17;106(25):3143-421.[Abstract][Full Text]
59. Young L, Cho L. Unique cardiovascular risk factors in women. Heart. 2019 Nov;105(21):1656-60.[Abstract][Full Text]
60. McCord J, Jneid H, Hollander JE, et al; American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation. 2008 Apr 8;117(14):1897-907.[Abstract][Full Text]
61. Um SW, Ohle R, Perry JJ. Bilateral blood pressure differential as a clinical marker for acute aortic dissection in the emergency department. Emerg Med J. 2018 Sep;35(9):556-8.[Abstract]
62. Pesola GR, Pesola HR, Lin M, et al. The normal difference in bilateral indirect blood pressure recordings in hypertensive individuals. Acad Emerg Med. 2002 Apr;9(4):342-5.[Abstract][Full Text]
63. Bautz B, Schneider JI. High-risk chief complaints I: chest pain-the big three (an update). Emerg Med Clin North Am. 2020 May;38(2):453-98.[Abstract]
64. Gross GE, Eisert L, Doerr HW, et al. S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia. J Dtsch Dermatol Ges. 2020 Jan;18(1):55-78.[Abstract][Full Text]
65. Jain A, Mehta N, Secko M, et al. History, physical examination, laboratory testing, and emergency department ultrasonography for the diagnosis of acute cholecystitis. Acad Emerg Med. 2017 Mar;24(3):281-97.[Abstract][Full Text]
66. Stepinska J, Lettino M, Ahrens I, et al. Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care. 2020 Feb;9(1):76-89.[Abstract][Full Text]
67. Adler Y, Charron P, Imazio M, et al; ESC Scientific Document Group. 2015 ESC guidelines for the diagnosis and management of pericardial diseases: the Task Force for the diagnosis and management of pericardial diseases of the European Society of Cardiology (ESC) endorsed by: the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015 Nov 7;36(42):2921-64.[Abstract][Full Text]
68. Expert Panel on Cardiac Imaging, Kicska GA, Hurwitz Koweek LM, et al. ACR Appropriateness Criteria® Suspected Acute Aortic Syndrome. J Am Coll Radiol. 2021 Nov;18(11s):S474-S481.[Abstract][Full Text]
69. Mueller C, Giannitsis E, Christ M, et al. Multicenter evaluation of a 0-hour/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T. Ann Emerg Med. 2016 Jul;68(1):76-87.e4.[Abstract][Full Text]
70. National Institute for Health and Care Excellence. High-sensitivity troponin tests for the early rule out of NSTEMI. Aug 2020 [internet publication].[Full Text]
71. Pickering JW, Than MP, Cullen L, et al. Rapid rule-out of acute myocardial infarction with a single high-sensitivity cardiac troponin T measurement below the limit of detection: a collaborative meta-analysis. Ann Intern Med. 2017 May 16;166(10):715-24.[Abstract][Full Text]
72. US Food and Drug Administration. Update: The FDA warns that biotin may interfere with lab tests: FDA safety communication. Nov 2019 [internet publication].[Full Text]
73. Roos A, Bandstein N, Lundbäck M,et al. Stable high-sensitivity cardiac troponin T levels and outcomes in patients with chest pain. J Am Coll Cardiol. 2017 Oct 31;70(18):2226-36.[Abstract][Full Text]
74. Kaura A, Panoulas V, Glampson B, et al. Association of troponin level and age with mortality in 250 000 patients: cohort study across five UK acute care centres. BMJ. 2019 Nov 20;367:l6055.[Abstract][Full Text]
75. Gallacher PJ, Miller-Hodges E, Shah ASV, et al. Use of high-sensitivity cardiac troponin in patients with kidney impairment: a randomized clinical trial. JAMA Intern Med. 2021 Sep 1;181(9):1237-9.[Abstract][Full Text]
76. Hertzberg D, Holzmann MJ, Than M, et al. Acute kidney injury in patients presenting with chest pain to the emergency department, a descriptive study of the most common discharge diagnoses and mortality. Eur J Emerg Med. 2019 Aug;26(4):242-248.[Abstract][Full Text]
77. Miller-Hodges E, Anand A, Shah ASV, et al. High-sensitivity cardiac troponin and the risk stratification of patients with renal impairment presenting with suspected acute coronary syndrome. Circulation. 2018 Jan 30;137(5):425-35.[Abstract][Full Text]
78. Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8.[Abstract][Full Text]
79. Poldervaart JM, Reitsma JB, Backus BE, et al. Effect of using the HEART score in patients with chest pain in the emergency department: a stepped-wedge, cluster randomized trial. Ann Intern Med. 2017 May 16;166(10):689-97.[Abstract]
80. Van Den Berg P, Body R. The HEART score for early rule out of acute coronary syndromes in the emergency department: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 2018 Mar;7(2):111-9. [Abstract]
81. Fernando SM, Tran A, Cheng W, et al. Prognostic accuracy of the HEART Score for prediction of major adverse cardiac events in patients presenting with chest pain: a systematic review and meta-analysis. Acad Emerg Med. 2019 Feb;26(2):140-151.[Abstract][Full Text]
82. Laureano-Phillips J, Robinson RD, Aryal S, et al. HEART score risk stratification of low-risk chest pain patients in the emergency department: a systematic review and meta-analysis. Ann Emerg Med. 2019 Aug;74(2):187-203.[Abstract][Full Text]
83. American College of Cardiology. The use of chest pain scores and high-sensitivity troponin for evaluating chest pain patients. May 2016 [internet publication].[Full Text]
84. American College of Radiology. ACR appropriateness criteria: chest pain - possible acute coronary syndrome. 2019 [internet publication].[Full Text]
85. Multimodality Writing Group for Chronic Coronary Disease, Winchester DE, Maron DJ, et al. ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 multimodality appropriate use criteria for the detection and risk assessment of chronic coronary disease. J Am Coll Cardiol. 2023 Jun 27;81(25):2445-67.
86. Morise AP, Haddad WJ, Beckner D. Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease. Am J Med. 1997 Apr;102(4):350-6.[Abstract]
87. Pryor DB, Shaw L, McCants CB, et al. Value of the history and physical in identifying patients at increased risk for coronary artery disease. Ann Intern Med. 1993 Jan 15;118(2):81-90.[Abstract]
88. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. 1979 Jun 14;300(24):1350-8.[Abstract]
89. Pryor DB, Harrell FE Jr., Lee KL, et al. Estimating the likelihood of significant coronary artery disease. Am J Med. 1983 Nov;75(5):771-80.[Abstract]
90. Expert Panel on Cardiac Imaging, Akers SR, Panchal V, et al. ACR Appropriateness Criteria® Chronic Chest Pain-High Probability of Coronary Artery Disease. J Am Coll Radiol. 2017 May;14(5s):S71-S80.[Abstract][Full Text]
91. Pontone G, Baggiano A, Andreini D, et al. Stress computed tomography perfusion versus fractional flow reserve CT derived in suspected coronary artery disease: the PERFECTION study. JACC Cardiovasc Imaging. 2019 Aug;12(8 pt 1):1487-97.[Abstract][Full Text]
92. NHS England. 3D heart scans on the NHS to speed up disease diagnosis. May 2021 [internet publication].[Full Text]
93. National Institute for Health and Care Excellence. Heart valve disease presenting in adults: investigation and management. Nov 2021 [internet publication]. [Full Text]
94. Guichard JL, Hage FG. Guidelines in review: 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS appropriate utilization of cardiovascular imaging in emergency department patients with chest pain: a joint document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Nucl Cardiol. 2016 Oct;23(5):1142-6. [Abstract]
95. Raja AS, Greenberg JO, Qaseem A, et al. Evaluation of patients with suspected acute pulmonary embolism: best practice advice from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2015 Nov 3;163(9):701-11.[Abstract][Full Text]
96. Penaloza A, Soulié C, Moumneh T, et al. Pulmonary embolism rule-out criteria (PERC) rule in European patients with low implicit clinical probability (PERCEPIC): a multicentre, prospective, observational study. Lancet Haematol. 2017 Dec;4(12):e615-21.[Abstract]
97. Freund Y, Cachanado M, Aubry A, et al; PROPER Investigator Group. Effect of the Pulmonary Embolism Rule-Out Criteria on subsequent thromboembolic events among low-risk emergency department patients: The PROPER randomized clinical trial. JAMA. 2018 Feb 13;319(6):559-66.[Abstract]
98. National Institute for Health and Care Excellence. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. Aug 2023 [internet publication].[Full Text]
99. Righini M, Perrier A, De Moerloose P, et al. D-dimer for venous thromboembolism diagnosis: 20 years later. J Thromb Haemost. 2008 Jul;6(7):1059-71.[Abstract][Full Text]
100. Dunn KL, Wolf JP, Dorfman DM, et al. Normal D-dimer levels in emergency department patients suspected of acute pulmonary embolism. J Am Coll Cardiol. 2002 Oct 16;40(8):1475-8.[Abstract][Full Text]
101. Crawford F, Andras A, Welch K, et al. D-dimer test for excluding the diagnosis of pulmonary embolism. Cochrane Database Syst Rev. 2016 Aug 5;(8):CD010864.[Abstract][Full Text]
102. Stals MAM, Takada T, Kraaijpoel N, et al. Safety and efficiency of diagnostic strategies for ruling out pulmonary embolism in clinically relevant patient subgroups : a systematic review and individual-patient data meta-analysis. Ann Intern Med. 2022 Feb;175(2):244-55.[Abstract]
103. Buhumaid RE, St-Cyr Bourque J, Shokoohi H, et al. Integrating point-of-care ultrasound in the ED evaluation of patients presenting with chest pain and shortness of breath. Am J Emerg Med. 2019 Feb;37(2):298-303.[Abstract]
104. Lamsam L, Gharahbaghian L, Lobo V. Point-of-care ultrasonography for detecting the etiology of unexplained acute respiratory and chest complaints in the emergency department: a prospective analysis. Cureus. 2018 Aug 28;10(8):e3218.[Abstract][Full Text]
105. Ben-Baruch Golan Y, Sadeh R, Mizrakli Y, et al. Early point-of-care ultrasound assessment for medical patients reduces time to appropriate treatment: a pilot randomized controlled trial. Ultrasound Med Biol. 2020 Aug;46(8):1908-15.[Abstract]
106. Zanobetti M, Scorpiniti M, Gigli C, et al. Point-of-care ultrasonography for evaluation of acute dyspnea in the ED. Chest. 2017 Jun;151(6):1295-301.[Abstract]
107. Wang WH, Huang JQ, Zheng GF, et al. Is proton pump inhibitor testing an effective approach to diagnose gastroesophageal reflux disease in patients with noncardiac chest pain?: a meta-analysis. Arch Intern Med. 2005 Jun 13;165(11):1222-8.[Abstract][Full Text]
108. Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013 Sep;108(9):1400-15; 1416.[Abstract][Full Text]
109. Simundic AM, Bölenius K, Cadamuro J, et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med. 2018;56(12):2015-38.[Abstract]
110. Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021 Apr 7;42(14):1289-367.[Abstract][Full Text]
111. Knuuti J, Ballo H, Juarez-Orozco LE, et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. Eur Heart J. 2018 Sep 14;39(35):3322-30.[Abstract][Full Text]
112. Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging - executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol. 2003 Oct 1;42(7):1318-33.[Abstract]
113. Tonino PA, Fearon WF, De Bruyne B, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol. 2010 Jun 22;55(25):2816-21.[Abstract][Full Text]
114. Expert Panel on Thoracic Imaging, Stowell JT, Walker CM, et al. ACR appropriateness criteria® nontraumatic chest wall pain. J Am Coll Radiol. 2021 Nov;18(11s):S394-405.[Abstract][Full Text]
115. Stochkendahl MJ, Christensen HW. Chest pain in focal musculoskeletal disorders. Med Clin North Am. 2010 Mar;94(2):259-73.[Abstract]
116. Roach PJ, Schembri GP, Bailey DL. V/Q scanning using SPECT and SPECT/CT. J Nucl Med. 2013 Sep;54(9):1588-96.[Abstract][Full Text]
117. Chow BJ, Larose E, Bilodeau S, et al. The 'what, when, where, who and how?' of cardiac computed tomography in 2009: guidelines for the clinician. Can J Cardiol. 2009 Mar;25(3):135-9.[Abstract][Full Text]
118. Piazza G, Goldhaber SZ. Acute pulmonary embolism: part I: epidemiology and diagnosis. Circulation. 2006 Jul 11;114(2):e28-32.[Abstract][Full Text]
119. Lange RA, Hillis LD. Clinical practice: acute pericarditis. N Engl J Med. 2004 Nov 18;351(21):2195-202. [Erratum in: N Engl J Med. 2005 Mar 17;352(11):1163.][Abstract]
120. von Kodolitsch Y, Nienaber CA, Dieckmann C, et al. Chest radiography for the diagnosis of acute aortic syndrome. Am J Med. 2004 Jan 15;116(2):73-7.[Abstract]
121. Rasool S, Abid S, Jafri W. Validity and cost comparison of 14carbon urea breath test for diagnosis of H Pylori in dyspeptic patients. World J Gastroenterol. 2007 Feb 14;13(6):925-9.[Abstract][Full Text]
122. Vilaichone RK, Mahachai V, Graham DY. Helicobacter pylori diagnosis and treatment. Gastroenterol Clin North Am. 2006 Jun;35(2):229-47.[Abstract]
123. Billittier AJ, Abrams BJ, Brunetto A. Radiographic imaging modalities for the patient in the emergency department with abdominal complaints. Emerg Med Clin North Am. 1996 Nov;14(4):789-850.[Abstract]
124. Kadakia SC. Biliary tract emergencies. Acute cholecystitis, acute cholangitis, and acute pancreatitis. Med Clin North Am. 1993 Sep;77(5):1015-36.[Abstract]
125. Rompianesi G, Hann A, Komolafe O, et al. Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis. Cochrane Database Syst Rev. 2017 Apr 21;4(4):CD012010.[Abstract][Full Text]
126. Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019 Jun 13:14:27.[Abstract][Full Text]
127. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jul-Aug;13(4 suppl 2):e1-15.[Abstract][Full Text]
128. American College of Radiology. ACR appropriatness criteria: acute pancreatitis. 2019 [internet publication].[Full Text]
129. Winnicka L, Shenoy MA. EVALI and the pulmonary toxicity of electronic cigarettes: a review. J Gen Intern Med. 2020 Jul;35(7):2130-5.[Abstract][Full Text]
130. Arter ZL, Wiggins A, Hudspath C, et al. Acute eosinophilic pneumonia following electronic cigarette use. Respir Med Case Rep. 2019 Mar 18:27:100825.[Abstract][Full Text]
131. Beltrame JF. Management of vasospastic angina. Heart. 2022 Dec 13;109(1):70-7.[Abstract]