Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome (ACS). Special Work-Up Algorithm.

[See Non-Cardiac Causes algorithm.]

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Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Oct. 76 p. Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome (ACS) Special Work-Up Algorithm Chest pain not related to CAD, but indicative of other serious diagnosis A = Annotation Clinical features suggest dissecting or symptomatic aneurysm? A Diagnosis of dissection, immediate CT angiogram or echo/TEE; MRI if clinically stable and patient asymptomatic. A Test diagnostic of Type A dissection or symptomatic aneurysm? A *Arrange for immediate cardiovascular surgery consultation. *Nitroprusside plus esmolol drip. A Sx, ABGs, CXR suggest pulmonary embolus? A Refer to ICSI VTE guideline for diagnosis and evaluation of PE Treatment of distal dissection *Control BP and HR with nitroprusside plus esmolol drip. *Target SBP 110-120. *Target HR 60-70 bpm (to minimize shearing forces). *CV surgery consultation. *Admit. A Sx, ABGs, CXR suggest pneumothorax? A Consider chest tube and hospitalization. A Sx, signs suggest pericardial disease? A Tamponade? A Pericardiocentesis -- prefer echo-directed. A Admit CCU/monitored bed. A Consider non-cardiac causes. See Non-Cardiac Causes algorithm. Echo; discharge?/Consider treatment. A All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.