EVALUATION OF THE PATIENT WITH RULE OUT MYOCARDIAL-INFARCTION

Evaluation in the emergency department of the patient with chest pain remains a common problem, Large numbers of patients are admitted to th e hospital because of diagnostic uncertainty. Strategies dealing with this population include risk stratification by clinical presentation, serial cardiac enzyme assays to exclude myocardial infarction, and det ection of myocardial ischemia with nuclear scintigraphy or echocardiog raphy. Each of these strategies is rational with specific benefits and weaknesses. Bypassing these steps and performing immediate exercise t esting is the newest approach that appears to be safe, timely, and cos t-effective.