Evaluation And Management Of Non-ST-Segment Elevation Acute Coronary Syndromes In The Emergency Department

Doshi, Ankur A. MD, FACEP
Iskyan, Kara MD
O'Neill, John M. MD
Sawyer, Kelly N. MD
Fesmire, Francis MD, FACEP
Silvers, Scott MD, FACEP

Authors
Ankur A. Doshi, MD, FACEP Assistant Professor of Emergency Medicine, Drexel University College of Medicine; Associate Program Director, Emergency Medicine Residency, Allegheny General Hospital, Pittsburgh, PA
Kara Iskyan, MD Resident, Emergency Medicine/Internal Medicine, Allegheny General Hospital, Pittsburgh, PA
John M. O'Neill, MD Assistant Professor of Emergency Medicine, Drexel University College of Medicine; Attending Faculty, Emergency Medicine Residency, Allegheny General Hospital, Pittsburgh, PA
Kelly N. Sawyer, MD Clinical Instructor of Emergency Medicine, Virginia Commonwealth University Medical Center, Emergent Cardiac Care Fellow, Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
Peer Reviewers
Francis Fesmire, MD, FACEP Director, Heart-Stroke Center, Erlanger Medical Center; Assistant Professor, UT College of Medicine, Chattanooga, TN
Scott Silvers, MD, FACEP Chair, Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL

Emergency Medicine Practice 12(1):p 1-26, January 2010.

As your shift begins, paramedics bring in a 69-year-old woman with chest pain. You glance in and see that she looks uncomfortable, with diaphoresis and shortness of breath. Your gut tells you that this is “the real deal,” a sick cardiac patient. The nurse quickly hands you the ECG, and no ST-segment elevations are evident. The patient was given aspirin and nitroglycerin by EMS personnel, but she is still experiencing pain. Questions run through your mind as you begin talking to the patient: Are there any new tests that can quickly diagnose a myocardial infarction? Which new treatments can be administered in the emergency department? What do you need to tell your cardiology colleague on the phone? Does it matter that the patient is female? After the examination is complete, you think of the best evidence for taking care of patients with non-ST-segment elevation acute coronary syndromes and begin treatment.