Cardiac imaging in the evaluation of patients presenting to the emergency department with chest pain

摘要

Each year in the United States, over 5 million persons present to the emergency department (ED) complaining of chest pain. Determining the exact etiology of their symptoms continues to present a diagnostic dilemma to physicians. Although the majority of patients have minor causes of chest pain, most of them will undergo an extensive workup to exclude acute myocar-dial ischemia, pulmonary embolism, or aortic dissection. Even though cardiac chest pain is the most common "serious" etiology, an acute coronary syndrome (ACS) or acute myocardial infarction (AMI) is eventually diagnosed in only-10 to 30 of these patients.1"3 This low-yield methodology currently practiced in today's hospitals is a waste of monetary and health care resources for those patients not found to have an ACS. On the other end of the spectrum, it is estimated that between 2 and 8 of patients inadvertently discharged from the ED will have an acute coronary event.Misdiagnosis and discharge lead to an increased mortality rate for those patients who have an' AMI outside of the hospital.