Overview :
Hamm and Braunwald used a simple algorithm
for evaluating a patient with acute chest pain. The authors
are from the Kerckhoff Heart Center in Germany and Bringham
and Women's Hospital in Boston.
Parameters evaluated:
(1) ECG for ST segment elevation
(2) initial serum troponin levels
(3) time since chest pain onset
(4) repeat
troponin serum levels in 4 hours (if presentation < 6 hours
after onset of chest pain)
Findings |
Diagnosis |
positive ECG for ST segment
elevation |
acute MI |
negative ST segment elevation,
elevated initial serum troponin |
unstable angina or acute MI |
negative ST segment elevation,
negative initial serum troponin, presentation more than
6 hours after onset of chest pain |
low risk for MI, other
diagnosis |
negative ST segment elevation,
negative initial serum troponin, presentation less than
6 hours after onset of chest pain, elevated serum
troponin on repeat specimen in 4 hours |
unstable angina or acute MI |
negative ST segment elevation,
negative initial serum troponin, presentation less than
6 hours after onset of chest pain, negative serum
troponin on repeat specimen in 4 hours |
low risk for MI, other
diagnosis |
|