Chest pain emergency units

Each year in the United States, more than 2 million patients are hospitaliz ed with chest pain suggestive of myocardial ischemia, with fewer than 20% o f these patients having an acute coronary event. Chest pain emergency units have been created to facilitate urgent therapy for patients with a serious cardiovascular event and to triage lower risk patients to less intensive, more cost-effective inpatient care or discharge to home, The clinical histo ry, physical examination, and initial electrocardiogram are key to initial stratification of patients for further management, but additional methods a re necessary to clearly distinguish patients with inconclusive findings at presentation as high- and low-risk. Innovative electrocardiographic methods have increased sensitivity for detecting myocardial ischemia, Accelerated diagnostic protocols with new cardiac serum markers can detect myocardial i schemia or infarction with increasing accuracy, Early echocardiographic, sc intigraphic, and treadmill stress protocols can further evaluate patients w ho have nondiagnostic electrocardiograms and negative serum markers. This r eview presents the current status of chest pain emergency units and the evo lving management strategies they encompass. Curr Opin Cardiol 1999, 14:321- 328 (C) 1999 Lippincott Williams & Wilkins, Inc.