As a DNB instructor, create a one‑hour PowerPoint presentation on evaluating acute chest pain in the emergency department, including difficult multiple‑choice questions, a take‑home message, and common pitfalls.

EVALUATION OF ACUTE CHEST PAIN IN THE EMERGENCY DEPARTMENT

A 1-Hour DNB Teaching Module with High-Difficulty MCQs

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SLIDE 1: LEARNING OBJECTIVES

By the end of this session, you will be able to:

• Obtain and interpret a 12-lead ECG within 10 minutes of patient arrival 1
• Identify the six immediately life-threatening causes of chest pain that can kill within minutes to hours 2
• Apply sex-specific troponin thresholds to avoid missing 30% of women with STEMI 2
• Recognize atypical presentations in women and elderly patients that lead to underdiagnosis 1
• Implement evidence-based clinical decision pathways for risk stratification 1

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SLIDE 2: THE CRITICAL FIRST 10 MINUTES

Mandatory Actions (Class I Recommendations)

The 10-Minute Rule: ECG acquisition and interpretation must occur within 10 minutes of arrival 1

Immediate parallel actions:

• Draw high-sensitivity cardiac troponin (hs-cTn) immediately—it is the most sensitive and specific biomarker for myocardial injury 1
• Assess vital signs: HR, BP in both arms, RR, SpO₂ 2
• Perform focused cardiovascular exam for diaphoresis, tachypnea, crackles, S3 gallop, new murmurs, pulse differentials 1, 2

Why this matters: Pre-hospital ECG reduces mortality by 17% and saves 23 lives per 1000 per hour of earlier treatment 2

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SLIDE 3: MCQ #1 (DIFFICULT)

A 24-year-old woman presents with substernal chest discomfort for 2 days, accompanied by jaw pain and nausea. She takes oral contraceptives. Vital signs: BP 118/76, HR 98, RR 22, SpO₂ 96%. Initial ECG shows sinus tachycardia. What is the MOST appropriate next step?

A. Reassure and discharge with NSAIDs for costochondritis
B. Order chest X-ray to rule out pneumonia
C. Draw high-sensitivity troponin and repeat at 1-3 hours
D. Prescribe proton pump inhibitor for GERD

Correct Answer: C

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SLIDE 4: MCQ #1 EXPLANATION

Why C is correct:

• Women are at high risk for underdiagnosis of ACS and more frequently present with jaw pain, nausea, and epigastric discomfort rather than classic chest pain 1, 2
• Do NOT dismiss ACS based solely on age (24 years)—underdiagnosis occurs across all age groups 2
• A single normal troponin does NOT exclude ACS—repeat hs-cTn at 1-3 hours is mandatory 1
• Use sex-specific hs-cTn thresholds (>16 ng/L for women vs >34 ng/L for men)—this reclassifies ~30% of women with STEMI who would be missed with universal cutoffs 2

Why other options are wrong:

• A: Age and atypical presentation do not exclude cardiac etiology 2
• B: Does not address cardiac evaluation first 1
• D: Assumes benign GI cause without excluding life-threatening cardiac disease 1

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SLIDE 5: THE SIX KILLERS—LIFE-THREATENING CAUSES

Must Exclude Within Minutes to Hours 2

Condition	Key Clinical Clue	Diagnostic Test
Acute Coronary Syndrome	Retrosternal pressure building over minutes, radiation to left arm/jaw/neck [1,2]	ECG + hs-cTn [1]
Aortic Dissection	Sudden "ripping/tearing" pain to back; pulse differential in ~30% [2]	CT/MRI/TEE [2]
Pulmonary Embolism	Sudden dyspnea + pleuritic pain; tachycardia >90% of cases [1,2]	Wells score → D-dimer or CTPA [2]
Tension Pneumothorax	Unilateral absent breath sounds, tracheal deviation, hypotension [2]	Clinical diagnosis → immediate decompression [2]
Cardiac Tamponade	JVD, hemodynamic compromise, friction rub [2]	Bedside echo → pericardiocentesis [3]
Esophageal Rupture	Severe pain after forceful vomiting; subcutaneous emphysema [2]	Chest CT, contrast esophagography [2]

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SLIDE 6: MCQ #2 (DIFFICULT)

A 68-year-old man with hypertension presents with severe chest pain that was maximal at onset 30 minutes ago. BP right arm 168/94, left arm 138/82. HR 102. ECG shows LVH with strain. Troponin pending. What is the SINGLE most important next step?

A. Administer aspirin 325 mg and start heparin
B. Activate STEMI protocol for primary PCI
C. Withhold antithrombotic therapy and obtain urgent CT aorta
D. Give sublingual nitroglycerin and morphine for pain

Correct Answer: C

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SLIDE 7: MCQ #2 EXPLANATION

Why C is correct:

• Pulse differential (systolic BP difference >20 mmHg between arms) occurs in ~30% of aortic dissections 2
• Pain maximal at onset is characteristic of dissection, not ACS which builds over minutes 1, 2
• Withhold aspirin and heparin if dissection is suspected—antithrombotic therapy can be catastrophic 2
• Immediate imaging (CT/MRI/TEE) is mandatory before any intervention 2

Why other options are wrong:

• A: Aspirin/heparin contraindicated in suspected dissection 2
• B: No ST-elevation present; dissection mimics ACS 2
• D: Pain control does not address life-threatening diagnosis 2

Critical Pitfall: Assuming all chest pain is ACS and giving aspirin reflexively can be fatal in aortic dissection 2

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SLIDE 8: ECG INTERPRETATION—BEYOND STEMI

What the ECG Tells You in the First 10 Minutes

STEMI criteria: ST-elevation ≥1 mm in contiguous leads → immediate reperfusion (door-to-balloon <90 min or door-to-needle <30 min) 1, 2

But 30-40% of acute MIs present with normal or nondiagnostic initial ECG 1, 2

Serial ECG strategy when initial ECG is nondiagnostic:

• Repeat ECG every 15-30 minutes if clinical suspicion remains high 1, 2
• Add posterior leads V7-V9 to detect posterior MI 1

Other ECG patterns to recognize:

• Pericarditis: Diffuse concave ST-elevation with PR-depression 2
• PE: Right ventricular strain pattern (S1Q3T3) 1
• Aortic dissection: May show LVH or be normal 2

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SLIDE 9: MCQ #3 (DIFFICULT)

A 78-year-old woman with diabetes presents with "indigestion" and fatigue for 6 hours. No chest pain. BP 102/68, HR 88. ECG shows nonspecific ST-T changes. Initial hs-cTn is 12 ng/L (normal <16 ng/L for women). What is the MOST appropriate management?

A. Discharge with PPI and follow-up in 1 week
B. Repeat hs-cTn at 1-3 hours and serial ECGs
C. Admit for stress test in the morning
D. Obtain chest X-ray and treat for pneumonia

Correct Answer: B

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SLIDE 10: MCQ #3 EXPLANATION

Why B is correct:

• Older adults (≥75 years) often present atypically with isolated dyspnea, fatigue, syncope, delirium, or unexplained falls—without classic chest pain 1, 2
• "Indigestion" and fatigue are anginal equivalents in elderly and diabetic patients 2
• A single normal hs-cTn does NOT exclude ACS—repeat at 1-3 hours is mandatory 1
• Patients with diabetes are more likely to have atypical symptoms and silent ischemia 2

Why other options are wrong:

• A: Discharging without serial troponins misses 30-40% of MIs with normal initial ECG 1, 2
• C: Stress testing is inappropriate in acute presentation with ongoing symptoms 1
• D: Does not address cardiac evaluation first 1

Critical Pitfall: Attributing vague symptoms to benign causes in elderly/diabetic patients leads to missed ACS 2

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SLIDE 11: TROPONIN INTERPRETATION—THE NUANCES

High-Sensitivity Troponin Protocol 1

Timing of serial measurements:

• hs-cTn: Repeat at 1-3 hours after initial draw 1
• Conventional troponin: Repeat at 3-6 hours 1

Single-sample rule-out strategy:

• Valid ONLY if symptom onset ≥3 hours before presentation, normal ECG, and hs-cTn below limit of detection 2

Sex-specific thresholds are critical:

• Women: >16 ng/L 2
• Men: >34 ng/L 2
• Using universal cutoffs misses ~30% of women with STEMI 2

Troponin elevation does NOT always mean ACS:

• Also elevated in: PE, myocarditis, pericarditis, heart failure, renal failure, sepsis 4
• Integrate troponin with clinical context, ECG, and imaging 4

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SLIDE 12: MCQ #4 (DIFFICULT)

A 52-year-old woman presents with sharp, pleuritic chest pain that worsens supine and improves leaning forward. Fever 38.2°C. ECG shows diffuse concave ST-elevation with PR-depression. Hs-cTn is 45 ng/L (elevated). What percentage of patients with pleuritic chest pain still have acute myocardial ischemia?

A. <1%
B. 5%
C. 13%
D. 25%

Correct Answer: C

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SLIDE 13: MCQ #4 EXPLANATION

Why C is correct:

• Sharp, pleuritic pain does NOT exclude ACS—approximately 13% of patients with pleuritic features still have acute myocardial ischemia 2
• This patient likely has acute pericarditis (fever, positional pain, diffuse ST-elevation with PR-depression, elevated troponin) 2, 3
• But pericarditis and ACS can coexist, especially post-MI (Dressler syndrome) 2

Clinical approach:

• Perform bedside echocardiography to detect pericardial effusion (~60% of acute pericarditis cases) and assess for tamponade 3, 5
• Rule out concurrent myocardial ischemia with serial troponins and ECGs 2

Critical Pitfall: Assuming pleuritic pain is always benign (pneumonia, pleurisy, costochondritis) without excluding cardiac causes 2

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SLIDE 14: RISK STRATIFICATION ALGORITHMS

Clinical Decision Pathways Should Be Used Routinely 1

High-risk features requiring immediate CCU admission:

• Ongoing rest pain >20 minutes 2
• Hemodynamic instability (SBP <100 mmHg, HR >100 or <50 bpm) 2
• Troponin above 99th percentile 2
• New heart failure signs (crackles, S3 gallop, new MR murmur) 1, 2

Intermediate-risk features:

• Age >70 years 2
• Prior MI or known CAD 2
• Diabetes, hypertension, hyperlipidemia, smoking, family history of premature CAD 1, 2

Low-risk criteria for chest-pain unit observation or discharge:

• Normal/nondiagnostic ECG 2
• Negative hs-cTn at presentation and 6-12 hours 2
• Stable vitals, no ongoing pain, no heart failure signs 2

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SLIDE 15: MCQ #5 (DIFFICULT)

A 45-year-old man with ventricular pacemaker and diastolic heart failure presents with new left-sided chest pressure on two separate days. ECG shows ventricular-paced rhythm. What is the MOST reliable method to detect acute myocardial injury in this patient?

A. Serial 12-lead ECGs to detect ST-segment changes
B. High-sensitivity troponin measurement
C. Immediate stress echocardiography
D. Coronary CT angiography

Correct Answer: B

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SLIDE 16: MCQ #5 EXPLANATION

Why B is correct:

• Ventricular-paced rhythm masks or mimics ischemic ECG changes—ST-segments and T-waves are abnormal at baseline 2
• High-sensitivity troponin remains the most sensitive and specific biomarker for myocardial injury and is not altered by pacemaker rhythm 2
• Serial hs-cTn at 1-3 hours is mandatory because a single normal result does not exclude ACS 1

Why other options are wrong:

• A: Paced rhythm makes ECG interpretation unreliable for ischemia 2
• C: Stress testing is inappropriate in acute presentation with ongoing symptoms 1
• D: Not first-line for acute evaluation; troponin must be checked first 1

Management approach:

• Draw hs-cTn immediately and repeat at 1-3 hours 1
• If troponin elevated or clinical suspicion high → urgent coronary angiography 2

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SLIDE 17: SPECIAL POPULATIONS—WOMEN

Why Women Are Underdiagnosed 1, 2

Epidemiology:

• Chest pain is the predominant symptom in 87-92% of women with ACS—same as men 2
• But women are 8-10 years older at presentation (median age ~69 vs ~62 in men) 2

Accompanying symptoms more common in women:

• Jaw/neck pain: ~10% vs ~4% in men 2
• Nausea/vomiting: ~32% vs ~23% in men 2
• Epigastric discomfort, palpitations, inter-scapular pain: ~62% vs ~55% in men 2
• Dyspnea, fatigue, shortness of breath 1, 2

Diagnostic gaps:

• Women undergo coronary angiography less often (~74% vs ~84% in men) 2
• Women present ~1 hour later after symptom onset 2
• Women receive less aggressive pharmacologic and revascularization therapy 2

ACC/AHA 2021 Guideline recommendation:

• Abandon the term "atypical chest pain"—describe as "cardiac," "possibly cardiac," or "non-cardiac" 1, 2
• Assume cardiac etiology until proven otherwise 2

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SLIDE 18: MCQ #6 (DIFFICULT)

A 32-year-old woman on oral contraceptives presents with sudden dyspnea and right-sided pleuritic chest pain. HR 112, RR 28, SpO₂ 94% on room air. ECG shows sinus tachycardia with S1Q3T3 pattern. What is the MOST appropriate next step?

A. Obtain age-adjusted D-dimer
B. Proceed directly to CT pulmonary angiography
C. Start empiric heparin and obtain V/Q scan
D. Discharge with NSAIDs for pleurisy

Correct Answer: B

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SLIDE 19: MCQ #6 EXPLANATION

Why B is correct:

• Clinical presentation is high probability for PE: sudden dyspnea + pleuritic pain + tachycardia (>90% of PE cases) + oral contraceptive use (major risk factor) 1, 2
• S1Q3T3 pattern suggests right ventricular strain from PE 1
• When clinical suspicion is high, proceed directly to CT pulmonary angiography—do not delay for D-dimer 2
• Tachycardia and dyspnea are present in >90% of PE patients 2

Why other options are wrong:

• A: D-dimer is for low-to-intermediate probability; high probability warrants immediate CTPA 2
• C: V/Q scan is second-line; CTPA is preferred 2
• D: Discharging a high-probability PE patient is dangerous 2

Management after diagnosis:

• Stable patients → transfer to ED or chest-pain unit 2
• Hemodynamically unstable or RV enlargement → ICU with thrombectomy capability 2

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SLIDE 20: TRANSPORT AND PRE-HOSPITAL MANAGEMENT

Why EMS Transport Is Mandatory 1, 2

Advantages of EMS over personal automobile:

1. Pre-hospital ECG acquisition facilitates reperfusion if STEMI identified 1
2. Trained personnel can administer aspirin, nitroglycerin, morphine, defibrillation en route 1
3. Shorter travel time to ED 1
4. Personal automobile transport is associated with increased risk and should be avoided 1

Pre-hospital interventions:

• Chewed aspirin 162-325 mg in alert adults without allergy or active GI bleeding 2
• Sublingual nitroglycerin unless SBP <90 mmHg or HR <50 or >100 bpm 2
• IV morphine 4-8 mg (repeat 2 mg every 5 min) for pain relief—pain increases sympathetic drive and myocardial workload 2
• Supplemental oxygen 2-4 L/min ONLY if breathless, heart failure features, or low SpO₂—routine oxygen in normoxemic patients may be harmful 2

Office/outpatient setting:

• If ECG cannot be obtained on site → immediate EMS transfer to ED 1
• Do NOT delay transfer for troponin testing when ACS or other life-threatening cause is suspected 1, 2

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SLIDE 21: MCQ #7 (DIFFICULT)

A 58-year-old man with chest pain receives sublingual nitroglycerin in the ambulance and reports complete pain relief. The paramedic tells you "it's not cardiac because the nitro worked." What is your response?

A. Agree and cancel the troponin order
B. Explain that nitroglycerin response does NOT differentiate cardiac from non-cardiac pain
C. Discharge the patient with outpatient stress test
D. Obtain chest X-ray to rule out pneumonia

Correct Answer: B

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SLIDE 22: MCQ #7 EXPLANATION

Why B is correct:

• Do NOT rely on nitroglycerin response to differentiate cardiac from non-cardiac chest pain—esophageal spasm and other conditions may also improve 2
• This is a Class IIa, Level B recommendation from ACC/AHA guidelines 2
• Nitroglycerin is a smooth muscle relaxant and can relieve esophageal spasm, biliary colic, and other non-cardiac causes 2

Correct management:

• Proceed with standard evaluation: ECG within 10 minutes + hs-cTn immediately 1
• Serial troponins at 1-3 hours 1
• Risk stratification using clinical decision pathways 1

Critical Pitfall: Using nitroglycerin response as a diagnostic test leads to missed ACS 2

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SLIDE 23: DISPOSITION ALGORITHMS

STEMI Pathway 1, 2

ECG shows ST-elevation ≥1 mm in contiguous leads → Activate STEMI protocol immediately → Primary PCI (door-to-balloon <90 min) OR fibrinolysis (door-to-needle <30 min) → Transfer to 24/7 cardiac catheterization center

NSTE-ACS Pathway 1, 2

ECG shows ST-depression or T-wave inversions + elevated troponin → Admit to CCU with continuous cardiac monitoring → Dual antiplatelet therapy (aspirin + P2Y12 inhibitor) → Anticoagulation (heparin/enoxaparin/fondaparinux) → Plan urgent coronary angiography

Low-Risk Pathway 2

Normal/nondiagnostic ECG + negative hs-cTn at 0 and 6-12 hours + stable vitals → Observe in chest-pain unit for 10-12 hours OR → Discharge for outpatient stress testing within 72 hours

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SLIDE 24: MCQ #8 (DIFFICULT)

A 42-year-old woman presents with chest pain. ECG is normal. Initial hs-cTn is 8 ng/L (normal <16 ng/L). Symptom onset was 5 hours ago. Can you safely discharge her with a single troponin measurement?

A. Yes, because symptom onset was >3 hours ago and troponin is below limit of detection
B. No, repeat hs-cTn at 1-3 hours is mandatory regardless of timing
C. Yes, because the ECG is normal
D. No, admit for stress test in the morning

Correct Answer: A

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SLIDE 25: MCQ #8 EXPLANATION

Why A is correct:

• Single-sample rule-out strategy is valid when symptom onset ≥3 hours before presentation, normal ECG, and hs-cTn below limit of detection 2
• This patient meets all three criteria: onset 5 hours ago, normal ECG, hs-cTn 8 ng/L (below detection limit) 2

Why other options are wrong:

• B: Serial troponins are not mandatory when single-sample rule-out criteria are met 2
• C: Normal ECG alone is insufficient—30-40% of MIs have normal initial ECG 1, 2
• D: Stress testing is not indicated in low-risk patients who meet rule-out criteria 1

Important caveat:

• If symptom onset was <3 hours ago, serial troponins at 1-3 hours are mandatory 1
• If clinical suspicion remains high despite negative troponin, proceed with serial measurements 1

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SLIDE 26: COMMON PITFALLS—WHAT NOT TO DO

Critical Errors That Lead to Missed Diagnoses 1, 2

1. Assuming young age excludes ACS—it can occur in adolescents without risk factors 2

2. Dismissing women's symptoms as anxiety—women are at high risk for underdiagnosis 1, 2

3. Relying on normal physical exam—uncomplicated MI can present with completely normal findings 2

4. Using nitroglycerin response as a diagnostic test—esophageal spasm also responds 2

5. Assuming pleuritic pain is benign—13% of pleuritic chest pain is still MI 2

6. Delaying EMS transport for office-based testing—immediate transfer is essential 1, 2

7. Using the term "atypical chest pain"—this leads to misinterpretation as benign 1, 2

8. Discharging based on single normal troponin—repeat at 1-3 hours unless rule-out criteria met 1, 2

9. Giving aspirin reflexively—withhold if aortic dissection suspected 2

10. Ignoring pulse differentials—30% of aortic dissections have this finding 2

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SLIDE 27: MCQ #9 (DIFFICULT)

An 82-year-old man with dementia is brought in by family for "acting confused" for 6 hours. No chest pain reported. BP 88/54, HR 48. ECG shows sinus bradycardia with first-degree AV block. What is the MOST likely diagnosis?

A. Urinary tract infection with delirium
B. Acute coronary syndrome with cardiogenic shock
C. Medication overdose (beta-blocker)
D. Stroke

Correct Answer: B

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SLIDE 28: MCQ #9 EXPLANATION

Why B is correct:

• Older adults (≥75 years) often present atypically with isolated dyspnea, syncope, acute delirium, or unexplained falls—without classic chest pain 1, 2
• Hemodynamic instability (SBP <100 mmHg, HR <50 bpm) is a high-risk feature mandating immediate CCU admission 2
• Acute delirium in elderly patients should prompt consideration of ACS 2

Immediate management:

• Draw hs-cTn immediately 1
• Obtain 12-lead ECG (already done) 1
• Activate ACS protocol if troponin elevated 1, 2
• Consider temporary pacing if symptomatic bradycardia 2

Why other options are wrong:

• A: UTI does not explain hemodynamic instability 2
• C: Possible, but ACS must be ruled out first 1
• D: Stroke does not typically cause bradycardia and hypotension 2

Critical Pitfall: Attributing vague symptoms to "old age" or dementia without excluding cardiac causes 2

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SLIDE 29: TAKE-HOME MESSAGES

10 Evidence-Based Principles for Acute Chest Pain Evaluation

1. ECG within 10 minutes + hs-cTn immediately in ALL patients with suspected cardiac chest pain 1

2. Exclude the six killers first: ACS, aortic dissection, PE, tension pneumothorax, cardiac tamponade, esophageal rupture 2

3. 30-40% of MIs have normal initial ECG—serial ECGs every 15-30 min if suspicion high 1, 2

4. Use sex-specific troponin thresholds (>16 ng/L women, >34 ng/L men) to avoid missing 30% of women with STEMI 2

5. Women and elderly present atypically—jaw pain, nausea, fatigue, delirium, falls are anginal equivalents 1, 2

6. Repeat hs-cTn at 1-3 hours—single normal result does NOT exclude ACS unless rule-out criteria met 1, 2

7. EMS transport is mandatory for suspected life-threatening causes—do NOT delay for office testing 1, 2

8. Nitroglycerin response does NOT differentiate cardiac from non-cardiac pain—esophageal spasm also responds 2

9. Abandon "atypical chest pain"—use "cardiac," "possibly cardiac," or "non-cardiac" 1, 2

10. Use clinical decision pathways routinely for risk stratification and disposition 1

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SLIDE 30: FINAL MCQ #10 (MOST DIFFICULT)

A 55-year-old woman with hypertension presents with severe substernal chest pain radiating to the back. BP right arm 178/98, left arm 152/86. HR 108. You suspect aortic dissection. The patient asks about cost concerns and whether she can go home and return tomorrow. What is the MOST appropriate response?

A. "The Emergency Medical Treatment and Labor Act requires us to provide stabilizing treatment regardless of ability to pay, and delayed diagnosis of aortic dissection is fatal."
B. "Let's wait for the troponin result first before deciding."
C. "You can go home and return if symptoms worsen."
D. "We can schedule an outpatient CT scan next week to save costs."

Correct Answer: A

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SLIDE 31: FINAL MCQ #10 EXPLANATION

Why A is correct:

• EMTALA requires emergency departments to provide stabilizing treatment regardless of ability to pay 2
• Aortic dissection is immediately life-threatening—pulse differential (SBP difference >20 mmHg) occurs in ~30% of cases 2
• The cost of delayed diagnosis far exceeds the cost of emergency evaluation 2
• Many hospitals have financial assistance programs and charity care for emergency services 2

Immediate management:

• Withhold aspirin and heparin—antithrombotic therapy is contraindicated in suspected dissection 2
• Obtain urgent CT aorta (or MRI/TEE) 2
• Transfer to center with 24/7 aortic imaging and cardiac surgery capability 2

Why other options are wrong:

• B: Troponin does not diagnose dissection; imaging is required 2
• C: Discharging a suspected dissection patient is negligent 2
• D: Outpatient imaging for life-threatening condition is inappropriate 2

Critical Pitfall: Allowing cost concerns to delay evaluation of life-threatening conditions 2

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SLIDE 32: COMMON PITFALLS SUMMARY

Errors in History-Taking

• Using "atypical chest pain" terminology 1, 2
• Dismissing symptoms in young patients or women 1, 2
• Ignoring anginal equivalents (jaw pain, nausea, fatigue, dyspnea) 1, 2

Errors in Physical Examination

• Assuming normal exam excludes ACS 2
• Not checking BP in both arms 2
• Missing pulse differentials in suspected dissection 2

Errors in Diagnostic Testing

• Relying on single normal troponin 1, 2
• Not repeating ECG when initial is nondiagnostic 1, 2
• Using universal troponin cutoffs instead of sex-specific thresholds 2

Errors in Management

• Giving aspirin in suspected aortic dissection 2
• Using nitroglycerin response as diagnostic test 2
• Delaying EMS transport for office-based testing 1, 2

Errors in Disposition

• Discharging based on normal ECG alone 1, 2
• Not using clinical decision pathways 1
• Allowing cost concerns to delay life-threatening evaluations 2

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SLIDE 33: KEY REFERENCES

2021 ACC/AHA/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain 1

Praxis Medical Insights: Practical Summaries of Clinical Guidelines 2, 3, 6

BMJ Clinical Research: Evaluating Patients with Chest Pain in the Emergency Department 4

European Journal of Emergency Medicine: Role of Urgent Transthoracic Echocardiography 5