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Ebook Braunwald's heart disease - A textbook of cardiovascular medicine (2-Volume set - 10th edition): Part 2

(BQ) Part 2 book "Braunwald's heart disease - A textbook of cardiovascular medicine" presents the following contents: Atherosclerotic cardiovascular disease; diseases of the heart, pericardium and pulmonary vasculature bed; cardiovascular disease in special populations, cardiovascular disease and disorders of other organs,. | 50 Approach to the Patient with Chest Pain A Marc S. Sabatine and Christopher P Cannon w CAUSES OF ACUTE CHEST PAIN 1057 Myocardial Ischemia or Infarction 1057 Pericardial Disease 1057 Vascular Disease 1058 Pulmonary Conditions 1058 Gastrointestinal Conditions 1059 Musculoskeletal and Other Causes 1059 DIAGNOSTIC CONSIDERATIONS 1059 Clinical Evaluation 1059 Initial Assessment 1059 Decision Aids 1062 IMMEDIATE MANAGEMENT 1062 Chest Pain Protocols and Units 1062 Early Noninvasive Testing 1065 REFERENCES 1066 Acute chest pain is one of the most common reasons for seeking care in the emergency department ED and it accounts for approximately 8 million ED visits annually in the United States. Such pain suggests acute coronary syndrome ACS but after diagnostic evaluation only 15 to 25 of patients with acute chest pain actually have ACS.1 2 The difficulty lies in discriminating patients with ACS or other lifethreatening conditions from those with noncardiovascular non-lifethreatening chest pain. The diagnosis of ACS is missed in approximately 2 of patients which can lead to substantial consequences for example the short-term mortality in patients with acute myocardial infarction MI who are mistakenly discharged from the ED increases twofold over that expected for patients who are admitted to the hospital. For patients with a lower risk for complications however these concerns must be balanced against the cost and inconvenience of admission and against the risk for complications from tests and procedures with a low probability of improving patient outcomes. Several recent advances have enhanced the accuracy and efficiency of evaluation of patients with acute chest pain including better blood markers for myocardial injury3 decision aids to stratify patients according to their risk for complications early exercise testing4 radionuclide scanning for lower risk patient subsets5 see Chapter 16 multislice computed tomography for anatomic evaluation of coronary artery disease CAD