Triage of Patients with Acute Chest Pain and Possible Cardiac Ischemia: The Elusive Search for Diagnostic Perfection

  1. Lee Goldman, MD; and
  2. Ajay J. Kirtane, MD*
  1. From the University of California, San Francisco, San Francisco, California.

    Abstract

    Few diagnostic decisions in medicine have been more heavily researched than the approach to the patient with acute chest pain. Despite the advances in both diagnosing and treating patients presenting with this symptom, cases of missed myocardial infarctions still cause substantial morbidity and mortality. This article examines a case in which a patient was sent home from the emergency department after presenting with chest pain and was subsequently found to have a myocardial infarction. In the context of the case, the article discusses clinical decision making about the diagnosis and triage of patients presenting with acute chest pain or with symptoms consistent with possible cardiac ischemia. A standardized approach to addressing the management of these patients is essential, given the adverse consequences of missing a life-threatening condition.

    For a list of questions and answers from the Quality Grand Rounds conference, see the Appendix.

    Article and Author Information

    • *This paper was prepared by Lee Goldman, MD, and Ajay J. Kirtane, MD, for the Quality Grand Rounds Series. Kaveh G. Shojania, MD, prepared the case for presentation. The case and discussion were presented at the 2002 Annual Session of the American College of Physicians in Philadelphia, Pennsylvania, on 11–14 April 2002.

    • Grant Support: Funding for the Quality Grand Rounds series is supported by the California HealthCare Foundation as part of its Quality Initiative.

    • Potential Financial Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Lee Goldman, MD, Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0120.

    • Current Author Addresses: Dr. Goldman: Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0120.

    • Dr. Kirtane: Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215.

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    This Article

    1. Ann Intern Med December 16, 2003 vol. 139 no. 12 987-995
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