ABSTRACT
The patient who presents with chest pain needs to be thoroughly evaluated. A complete history and physcial is first undertaken, taking special care to note the presence of cardiac risk factors: history of premature family history of CAD, hy pertension, diabetes, obesity, hypercholesterolemia and smoking. A physical ex amination should focus on the cardiovascular system, followed by laboratory as sessment of cardiac enzymes (troponin, CPK and MB), a chest x-ray and electro cardiogram. Suspicion of an acute coronary syndrome (unstable angina or acute myocardial infarction) requires oxygen therapy, nitrates and aspirin therapy (un less contraindicated), blood pressure therapy (first line therapy of acute coronary syndromes is beta blockers) and serial electrocardiograms and cardiac enzymes. Evidence of an acute myocardial infarction by either enzyme analysis or electro cardiogram usually requires immediate therapy with either thrombolytics or angioplasty. Currently there are several thrombolytics on the market, and utiliza tion varies depending upon multiple factors including the location of infarction. Furthermore, studies demonstrate reduced morbidity and mortality with other antiplatelet agents (clopidrogrel and Ilb-IIIa inhibitors) as well as heparin, either unffactionated or fractionated. The patient, depending upon their status, may be admitted to a chest pain unit (myocardial infarction unlikely) or a coronary care unit (present or likely infarction).
