Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome (ACS). Clinic Evaluation 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) Clinic Evaluation Algorithm Patient presents with chest pain or discomfort A = Annotation Initial focused assessment for high risk history, physical exam and other findings. A Unstable presentation? Initiate emergency interventions and transfer to ED as appropriate. A CA diagnosis secure? A Refer to ISCI Stable CA guideline. A For expanded discussion, refer to ICSI Cardiac Stress Test Supplement. Ischemic heart pain possible? A Choose stress test. Cardiology referral optional. A Can patient walk? A Do pharmacologic imaging study Resting ECG interpretable? A Do exercise imaging study. A Do regular treadmill stress test. A Is test strongly positive? A Is patient a candidate for revascularization? A Cardiology referral/consultation Refer to ICSI Stable CAD guideline Is test positive but low risk? A Is diagnostic certainty adequate? A Cardiology referral/consultation Refer to ICSI Stable CAD guideline Is test equivocal? A Is diagnostic certainty adequate? A Cardiology referral/consultation Test is normal. A *Low risk empiric treatment. *Non-cardiac evaluation. Consider non-cardiac causes, box #91 Is diagnostic certainty adequate? Cardiology referral/consultation All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.