Should a patient with tachycardia and chest pain go to the ER?

Emergency Department Referral for Tachycardic Patient with Chest Pain

A patient who is tachycardic at 110 bpm with a BP of 138/88 and complaining of chest pain should immediately go to the emergency department. This recommendation is based on current guidelines that prioritize rapid evaluation of potential acute coronary syndrome (ACS) to reduce morbidity and mortality.

Rationale for Emergency Department Referral

• The combination of chest pain and tachycardia (heart rate >100 bpm) represents a high-risk presentation that requires immediate evaluation 1
• Current guidelines from the American College of Cardiology/American Heart Association explicitly state that patients with suspected ACS and high-risk features such as continuing chest pain should be referred immediately to the emergency department 1
• Even with normal blood pressure (138/88 mmHg), tachycardia with chest pain warrants urgent evaluation as it may indicate:
  • Acute coronary syndrome (unstable angina or myocardial infarction)
  • Aortic dissection
  • Pulmonary embolism
  • Other life-threatening cardiac conditions

Risk Assessment

The patient's presentation includes multiple concerning features:

1. Tachycardia (110 bpm): Tachycardia can both cause myocardial ischemia and be a response to it 2
2. Chest pain: A cardinal symptom requiring evaluation for potentially life-threatening conditions
3. Combination of symptoms: The European Society of Cardiology guidelines emphasize that chest pain with tachycardia requires immediate evaluation 1

Transport Recommendations

• Activation of emergency medical services (EMS/911) is recommended rather than self-transport 1
• Guidelines specifically state: "Patients with suspected ACS should be taken to the nearest appropriate hospital" 1
• Studies show that approximately 1 in 300 patients with chest pain transported by private vehicle goes into cardiac arrest en route 1

Immediate Actions While Awaiting EMS

• Remain at rest to reduce cardiac workload
• If prescribed and available, consider taking aspirin (unless contraindicated)
• Do not delay transport to self-medicate or "wait and see" if symptoms resolve

Why Not Wait or Self-Monitor?

• Early intervention is critical for improving outcomes in ACS
• Patients who arrive at the hospital more than 2 hours after symptom onset have significantly higher mortality rates 3
• Only about 4% of patients presenting with chest pain have an obvious myocardial infarction on initial evaluation, but many more are ultimately diagnosed with ACS 4
• The European Heart Journal guidelines emphasize that even in patients with normal ECGs, high-sensitivity cardiac troponin testing is essential for diagnosis 1

Common Pitfalls to Avoid

1. Dismissing symptoms due to normal blood pressure: Even with normal BP, tachycardia with chest pain requires evaluation
2. Self-transport: Increases risk of complications during transport without medical support
3. Delayed presentation: Patients at higher risk (older, diabetic, hypertensive) often delay seeking care, leading to worse outcomes 3
4. Assuming non-cardiac cause: Chest pain with tachycardia should be presumed cardiac until proven otherwise

The combination of chest pain and tachycardia requires prompt medical evaluation in an emergency setting, regardless of blood pressure readings or the patient's perception of symptom severity.