Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
|Section 27. Principles of Imaging >|
Chapter e299.1. Noninvasive Myocardial Imaging
Sections: Noninvasive Myocardial Imaging: Introduction, General Concepts of Stress Imaging, Myocardial Perfusion Imaging, Stress Echocardiography, CT, MRI, Summary, Acknowledgments, References.
Excerpt:"Approximately 6 million patients are evaluated in the ED setting
for chest pain or symptoms suggestive of an acute coronary syndrome (ACS)
each year.1 A small number of these patients will
present with ST-segment elevations on their initial 12-lead ECG
and go on to immediate thrombolysis or percutaneous coronary intervention.
A much larger subset of these patients with chest pain will ultimately
be found to have an alternative diagnosis other than ACS. Unfortunately,
these patients with nonischemic chest pain often exhibit symptoms
that are no different than patients with true myocardial ischemia.
Indeed, no symptom alone or in combination is sufficiently discriminatory
to preclude further diagnostic workup.2 Initial
serologic markers of cardiac injury (total creatine phosphokinase
and its MB subfraction, troponin) and ECG changes are also nondiagnostic
in this subset of patients, with very poor sensitivities of 20% and
50%, respectively.3,4 Thus, emergency
physicians routinely face the question of how to manage patients
who are at a non-negligible risk for ischemic chest pain, but have
no certain diagnostic indications of ACS on presentation to the
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