Evaluation of the emergency department chest pain patient

Patients presenting to the emergency department with chest pain are a commo n and perplexing problem. Because of the limitations of the initial evaluat ion, most patients are admitted, although many are found to have noncardiac causes of their symptoms, Recognition of these limitations has driven the investigation-of newer evaluation techniques and protocols in an attempt to improve diagnostic sensitivity without increasing overall costs. These hav e included modifications of the standard electrocardiogram and use of newer myocsrrdial markers of necrosis, such as mass assays far CK-MB as well as troponin T and troponin I. Use of acute rest myocardial perfusion imaging a lso has been shown to be a highly valuable technique for risk stratificatio n of the intermediate- to low-risk chest pain patient. (C)2000 by Excerpta Medica, Inc.