Short Stay Management of Chest Pain

Acute coronary syndrome (ACS) continues to challenge our health care system in the complexity of presentation and the ever increasing number of patients exhibiting signs and symptoms of an acute coronary syndrome.

I. Introduction 2 Peacock II. Epidemiology and Demographics of Coronary Artery Disease 5 Dadkah III. Financial Impact of Chest Pain 10 Sieck a. US costs b. Economic case for a short stay unit IV. Why have a chest pain unit? 10 Toth a. QI data b. Outcomes data c. Financial aspects V. Pathophysiology and Definition of ACS 10 Amsterdam a. Unstable Angina b. NSTEMI c. STEMI VI. Emergency Department presentation 10 Collins a. Common presentations b. Confounders (gender, age, etc) c. Differential diagnosis d. Guideline recommendations 5 i. ECG time ii. Marker turn around time VII. Risk Stratification Storrow a. History and Physical 5 b. ECG 12 i. 12 lead ii. Future developments c. Cardiac Markers 15 Christianson i. Necrosis markers 1. Troponin I/T 2. CKMB 3. Myoglobin 4. Future developments ii. Ischemia markers 1. Ischemia Modified Albumin 2. Myeloperoxidase (MPO) 3. Future developments iii. Point of care vs lab iv. Confounders 1. Renal failure 2. Recent cardiac procedures 3. Re-infarction v. Panels vi. Future developments d. Scoring systems 10 Hollander i.