EMERGENCY DEPARTMENT EVALUATION OF THE CHEST PAIN PATIENT

Evaluation of the Elderly Patient with Acute Chest Pain

Chest pain is one of the most common and serious chief complaints. Geriatricians must be well versed in evaluating elderly patients who have chest pain. This article discusses the initial diagnostic evaluation of elderly patients with chest pain. Specific emphasis is placed on identifying acute coronary syndromes, aortic dissection, pulmonary embolism, and pericarditis with cardiac tamponade. By understanding the different presentations of these potentially life-threatening emergencies, the geriatrician will be better prepared to distinguish them from less dire conditions and to initiate prompt treatment.

Initial approach to the patient who has chest pain

The last decade has seen extraordinary advances in the cardiovascular arena, particularly in the evaluation and management of the patient who has acute coronary syndromes. From bedside markers of myocardial damage to drug-eluting stents, technical advances are proliferating. Efforts in developing an international registry for acute aortic dissection have helped elucidate the acute presentation, management, and prognosis of this uncommon but lethal disease. Finally, the multiple research efforts in coordinating clinical decision-making with serologic markers and advanced imaging for the diagnosis of pulmonary embolism is changing the approach to the patient at risk for thromboembolic disease.

Initial Evaluation of Chest Pain

Chest pain is among the most frequently evaluated presenting complaints in the emergency department (ED). Diagnostic etiologies range from benign to life-threatening. Failure to diagnose the life-threatening chest emergencies-specifically acute coronary syndrome, aortic dissection, and pulmonary embolism-can lead to catastrophic medical and legal outcomes for the patient and physician respectively. This article focuses on clinical and risk management strategies to minimize misdiagnosis and produce favorable medical and medicolegal outcomes.