Contents

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 1Background

 2Clinical Features

o 2.1Risk of ACS

 3Differential Diagnosis

o 3.1Chest pain

 3.1.1Critical

 3.1.2Emergent

 3.1.3Nonemergent

 4Evaluation

o 4.1Workup

 4.1.1Younger patients/less concerning story

 4.1.2Older patients/more concerning story

o 4.2Diagnosis

 5Management

 6Disposition

 7See Also

 8Videos

 9References

Background
Clinical Features

Risk of ACS
Clinical factors that increase likelihood of ACS/AMI:[1][2]

 Chest pain radiating both arms > R arm > L arm

 Chest pain associated with diaphoresis
 Chest pain associated with nausea/vomiting
 Chest pain with exertion
Clinical factors that decrease likelihood of ACS/AMI:[3]
 Pleuritic chest pain
 Positional chest pain
 Sharp, stabbing chest pain
 Chest pain reproducible with palpation
Gender differences in ACS

 Women with ACS are less likely to be treated with guideline-directed medical therapies, less likely
to undergo cardiac catheterization, and less likely to receive timely reperfusion.[4]
 Men are more likely to report central chest pain, while women are more likely to report fatigue,
dyspnea, indigestion, nausea/vomiting, palpitations and weakness[5], although some studies have
found fewer differences in presentation[6]
 Women are more likely to delay presentation. Additional factors associated with delay in seeking
treatment include older age, Black or Hispanic race, and lower education and socioeconomic
levels.[7]