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Cardiac Testing, Emergency Medicine

Reviewed 06/2017



  • Cardiac testing is indicated for emergency patients at risk for heart failure (HF) or acute coronary syndrome (ACS).

  • These pathologies may be thought of as a spectrum: Unstable angina...


Signs and Symptoms


  • Anginal symptoms usually are produced by bodily stresses, including exertional and emotional events, and relieved by rest.

  • ACS is less likely when chest pain is sharp...



  • Cardiac monitoring

  • Out-of-hospital EKG:

    • Alone has a sensitivity of 76% and specificity of 88% for ACS.

    • Alone has a sensitivity of 68% and specificity of 97% for AMI.

Initial Stabilization/Therapy



Admission Criteria

  • History suggestive of cardiac etiology for chest pain and ED observation for serial testing unavailable

  • Abnormal or changed EKG and ED observation unavailable

  • Posi...

Pearls and Pitfalls

  • Normal EKG or enzymes do not rule out CAD.

  • Repeat EKG or additional leads improve sensitivity in detecting AMI.

  • Most ED patients with undifferentiated chest pain will need some form ...

Additional Reading

  • Cardiac Radionuclide Imaging Writing Group. Criteria for Cardiac Radionuclide Imaging. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Ima...



  • 89.59 Other nonoperative cardiac and vascular measurements

  • 411.1 Intermediate coronary syndrome

  • 413.9 Other and unspecified angina pectoris

  • 89.52 Electrocardiogram


  • I20.9 Angina pectoris, un...

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