Feature Article

Acute assessment of possible cardiac chest pain

Louise Cullen, William Parsonage



Many changes have occurred recently in the assessment of patients presenting with possible acute coronary syndromes. The introduction of more sensitive cardiac troponin assays and the development of rapid assessment strategies is redefining the care of this group of patients.

Key Points

  • Determination of a patient’s risk of an acute coronary syndrome (ACS) should not be based on symptoms and signs alone.
  • The use of formal risk stratification is encouraged to determine a patient’s probability of having an ACS.
  • Highly sensitive troponin assays allow more rapid serial measurement of cardiac troponin for the identification of myocardial necrosis.
  • Accelerated diagnostic protocols (ADPs) are now being used to rapidly identify low risk patients in the emergency setting for early discharge and outpatient management.