With patients presenting with chest pain six to eight million times each year, it’s understandable that clinicians in the ER need to be well versed on properly identifying the symptoms of a heart issue/attack. Many other conditions mimic the typical heart attack “chest pain,” so we asked Matt Astin, M.D., ApolloMD physician and Medical Director, to help break down chest pain in his experience.
How often do patients come into the ER complaining of chest pain?
Chest pain is the second most common complaint in emergency departments, behind abdominal pain. One recent estimate put the number of visits at 6-8 million per year.
Which tests are used to determine the diagnosis?
An ECG is the only mandatory test related to chest pain. Other testing is directed from the patient’s history, physical examination and risk factors. Such tests may include a CBC, basic or comprehensive metabolic panel and chest x-ray. The troponin test has become the standard for assessment of acute coronary syndromes. The use of myoglobin, CK and even CK-MB is no longer being pushed by the cardiology specialty societies.
Of those patients, how many end up being admitted?
Admission of chest pain patients varies at each facility. Each patient should have some form of risk stratification of their cardiac risk performed. Generally, many patients are admitted. There is a push, however, to discharge low risk patients home from the ED. In order for this to occur, the patient must be low risk through some risk stratification tools (e.g., the HEART score) and be able to have timely follow-up. This last point, or lack thereof, is the reason many patients are admitted.
Is there a patient that stands out in your mind?
A 54 year-old man came to the ED complaining of indigestion. Upon presentation, he was symptom free. He had only a couple of cardiac risk factors. His initial ECG and labs were unremarkable. He had another episode of pain in the ED and a repeat ECG showed a subtle change. This prompted admission. The next morning, his ECG was dramatically worse. He was taken to the Cath lab, where a 100 percent LAD lesion was stented. This stresses the importance of the emergency medicine physician’s expertise in ECG reading.
Does your department have any new technologies or innovative processes?
My department does not currently have anything new or innovative. However, it will be interesting to see how things change since the FDA recently approved the “high-sensitivity troponin assay” for use in the USA.
What are ways to keep your heart healthy?
It doesn’t take much to keep a heart healthy. Not smoking is a big part. The recommendations for low fat diets is coming under scrutiny, so it all comes back to moderation. Also, physical activity is huge. The current recommendations are to get 30-minutes of exercise on most days. The 30-minutes can be broken up into smaller increments during the day. Going for a walk is the easiest way to increase your physical activity.
Matt Astin, M.D., has been working with ApolloMD for three years and is double board certified in Emergency Medicine and Internal Medicine. He serves as a Regional Medical Director of Emergency Medicine and Hospital Medicine. Currently, he is the medical director and chairman of emergency medicine at Southern Regional Medical Center in Riverdale, Ga. He also serves as the medical director for the Central Georgia Technical College paramedic program and as team physician for Mercer University Athletics. Matt lives in Macon, Georgia with his two children, Kayla and Devon.
