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Diagnosis and Management

of Chest Pain and Acute

Coronary Syndrome

(ACS)Unstable Angina/NSTM!

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Continuing Medical !m"lementation #$$.bridging the care gap

!nitial A""roach

%$ !s the "resenting sym"tom&

' ty"ical angina

' aty"ical angina

'nonanginal chest "ain

*$ +o, do you define each of the abo-e

.$ hat is this "atient0s clinical li1elihood of CAD

2$ Does the "atient re3uire immediate thera"y

4$ hat in-estigations are indicated hen5$ Does the "atient re3uire coronary angiogra"hy

6$ Does the "atient re3uire re-asculari7ation

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Continuing Medical !m"lementation #$$.bridging the care gap

Chest Pain Differential

8 Angina

8 Pericarditis

8 Pleurisy

8 Pulmonary

mbolism

8 Aortic dissection

8 so"hagealreflu9/s"asm

8 Pe"tic/biliary/colonicreferred "ain

8 Chest ,all "ain

8 Neurogenic "ain

' C disc disease

' Thoracic outlet

' shingles

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Continuing Medical !m"lementation #$$.bridging the care gap

Categori7e the Chest Pain

Typical angina

%$ :etrosternal com"onent

*$ ;rought on by stress or e9ercise

.$ :elie-ed "rom"tly by rest or NT