Abstract
Correctly identifying and appropriately triaging patients who present to the ED with
the broad range of symptoms suggestive of acute cardiac ischemia (ACI: unstable angina
pectoris [UAP] and acute myocardial infarction [AMI]) remains one of the greatest
challenges in EM. Although a number of diagnostic technologies have been described
to aid in this triage process, each of these tests or technologies has limitations.
We report a case series in which either the use of adjuncts with unknown performance
or tests with known but not considered limitations could have contributed to the failure
to appropriately triage and treat patients with ACI. Each case illustrates different
aspects of this clinical challenge. One case illustrates the hazards of reliance on
a single set of negative cardiac biomarkers. The limitations of a negative exercise
electrocardiographic stress test (ETT) are illustrated in the second case. Finally,
the limitations of a negative coronary angiogram, the “gold standard” test for symptomatic
coronary artery disease, are discussed. We review the literature on technologies to
aid in the evaluation of patients who present to the ED with symptoms suggestive of
ACI.
Keywords
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Article Info
Publication History
Accepted:
May 17,
2003
Received:
April 24,
2003
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
