Cardiovascular Medicine
Chest Pain
Evaluate acute chest pain with immediate ECG, high-sensitivity troponin, and structured risk pathways while actively excluding ACS, aortic syndromes, pulmonary embolism, and other lethal alternatives. Stable symptoms require contemporary pretest assessment and selective anatomic or functional testing rather than routine testing.
Immediate triage
Separate unstable from stable presentations before choosing a test
The first decision is disposition, not test modality.
Acute chest pain is new discomfort or a change in pattern, intensity, or duration. Stable chest pain is chronic and consistently provoked by exertion or emotional stress. In any acute presentation, prioritize ACS, acute aortic syndrome, pulmonary embolism, tension pneumothorax, and esophageal rupture before pursuing outpatient-style ischemia testing. AHA JournalsAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Features increasing ischemic concern include diffuse retrosternal pressure, tightness, heaviness, or squeezing that builds over minutes; exertional or emotional provocation; radiation to the arm, neck, jaw, back, or upper abdomen; and accompanying dyspnea, diaphoresis, nausea, palpitations, lightheadedness, or syncope. Brief pain lasting seconds, pain localized to a very small area, and pain that is positional or pleuritic lower—but do not eliminate—ischemic probability. Relief with nitroglycerin is not diagnostic. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Activate emergency evaluation for ongoing ischemic symptoms, hemodynamic instability, acute heart failure, malignant arrhythmia, syncope with concerning features, or suspected ACS within 12 hours when the ECG is abnormal or unavailable. nice org uknice org ukRecent-onset chest pain of suspected cardiac origin ...
Consider acute aortic syndrome with abrupt severe chest or back pain, especially with pulse differential, aortic regurgitation, connective-tissue disease, known aortic disease, or hypertension; CTA is the preferred diagnostic study in stable patients. AHA JournalsAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Consider pulmonary embolism with acute dyspnea and pleuritic pain; use clinical pretest assessment to select D-dimer testing or PE-protocol CTA. AHA JournalsAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
| Finding | Immediate implication | Next action |
|---|---|---|
| Persistent ischemic discomfort with ST-elevation or suspected STEMI equivalent | Probable acute coronary occlusion | Activate STEMI reperfusion pathway; do not delay reperfusion for troponin results. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... |
| New ischemic ST depression, dynamic T-wave change, or elevated/rising troponin | High-risk suspected NSTE-ACS or myocardial injury | Hospital-based ACS evaluation and risk-directed invasive management. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...AHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... |
| Abrupt tearing chest/back pain with dissection features | Possible acute aortic syndrome | Urgent aortic CTA if stable; use echocardiography to assess complications when relevant. AHA JournalsAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ... |
| Pleuritic pain with dyspnea or venous thromboembolism risk | Possible pulmonary embolism | Apply pretest-risk assessment; use D-dimer selectively or PE-protocol CTA. AHA JournalsAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ... |
Acute chest pain
Use ECG, high-sensitivity troponin, and a validated clinical decision pathway
No single symptom, ECG, or biomarker result safely rules out ACS in isolation.
Obtain a 12-lead ECG and interpret it within 10 minutes of presentation. Compare with prior tracings when available. A normal initial ECG is insufficient to exclude ACS; repeat ECGs for persistent or recurrent symptoms, clinical deterioration, or evolving concern. Obtain posterior leads when isolated ST depression in V1 through V3 raises concern for posterior infarction, and right-sided leads when inferior STEMI suggests right ventricular involvement. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...AHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
High-sensitivity troponin I or T is preferred for identifying or excluding myocardial injury. Myocardial injury is indicated by a value above the assay-specific 99th-percentile upper reference limit; MI requires a rise and/or fall in troponin with clinical evidence of ischemia. Interpret values using assay-specific thresholds, serial change criteria, symptom onset, ECG findings, and competing causes of injury. Elevated troponin may occur with noncoronary cardiac and noncardiac illness and should not automatically be labeled ACS. AHA Journals+2AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...AHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
Use an institutional clinical decision pathway rather than unstructured judgment alone. With hs-cTn, validated 0/1-hour, 0/2-hour, or other assay-specific serial strategies can identify patients at very low short-term risk. A single hs-cTn strategy is limited to patients with symptoms beginning at least 3 hours before testing and an assay result below the relevant low threshold. Conventional troponin assays require longer serial sampling, generally 3 to 6 hours after ED arrival. AHA Journals+2AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...AHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
A low-risk designation corresponds to <1% 30-day risk of death or MACE. Examples include HEART Pathway score ≤3 with initial and serial troponins below the assay 99th percentile, or hs-cTn values meeting low-value and low-delta criteria. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Low-risk patients do not routinely require immediate stress testing, CCTA, or admission solely for suspected CAD; arrange follow-up and address risk factors and alternate diagnoses. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Intermediate-risk patients without acute myocardial injury generally need observation-unit or inpatient evaluation and selective CCTA or stress imaging. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
High-risk features include new ischemic ECG changes, troponin-confirmed acute myocardial injury, new LVEF <40%, moderate-severe inducible ischemia, hemodynamic instability, or a high-risk clinical decision pathway score; invasive coronary angiography is indicated when ACS is confirmed or high-risk status is established. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...AHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
Suspected ACS
Begin time-sensitive treatment without obscuring the diagnosis
Management should proceed in parallel with diagnostic clarification.
For suspected ACS, EMS transport is preferred because prehospital monitoring, ECG acquisition, and treatment can reduce delays and support resuscitation if deterioration occurs. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... Aspirin should be given promptly unless contraindicated; the 2025 ACC/AHA ACS guideline recommends an oral loading dose of 162 to 325 mg followed by 75 to 100 mg daily. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
Do not administer supplemental oxygen routinely when oxygen saturation is at least 90%; provide oxygen for hypoxemia, with a target saturation of at least 90%. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... Sublingual nitroglycerin may be used in hemodynamically stable patients, but avoid it with suspected right ventricular infarction, systolic blood pressure below 90 mm Hg, or recent phosphodiesterase-5 inhibitor exposure. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
Patients with confirmed ACS require syndrome-specific antiplatelet therapy, parenteral anticoagulation, reperfusion or invasive management, and secondary prevention. The 2025 ACC/AHA guideline recommends ticagrelor or prasugrel over clopidogrel for ACS patients undergoing PCI, while recognizing bleeding-risk and contraindication tradeoffs. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
Avoid using symptom relief after nitroglycerin to establish or exclude myocardial ischemia. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Avoid nonaspirin NSAIDs for suspected or established ACS when possible because of increased cardiovascular risk. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
For patients with ACS at risk for gastrointestinal bleeding who receive DAPT or oral anticoagulation, use a proton pump inhibitor. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
In confirmed ACS, high-intensity statin therapy is recommended; reassess a fasting lipid panel 4 to 8 weeks after starting or changing lipid-lowering therapy. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
| Therapy | Source-supported regimen | Key restrictions |
|---|---|---|
| Aspirin | 162-325 mg orally as a loading dose; maintenance 75-100 mg orally daily. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... | Avoid with clear allergy or absolute contraindication. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... |
| Nitroglycerin | Sublingual 0.3 or 0.4 mg every 5 minutes as needed for up to 3 doses; IV infusion begins at 10 micrograms/min and is titrated to relief and hemodynamics when needed. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... | Avoid with SBP <90 mm Hg, suspected RV infarction, or recent PDE5 inhibitor exposure. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... |
| Morphine | IV 2-4 mg; may repeat every 5-15 minutes if needed. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... | Reserve for pain resistant to maximally tolerated anti-ischemic therapy; may delay oral P2Y12 inhibitor effect. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... |
| Oxygen | Give for peripheral oxygen saturation <90%; routine oxygen offers no benefit in normoxemic suspected MI. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... | Avoid liberal oxygen in normoxemia. AHA JournalsAHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ... |
Stable symptoms
Estimate pretest probability before ordering noninvasive testing
Test selection should answer a specific anatomic or ischemic question.
For stable symptoms without known CAD, use a contemporary pretest estimate based on age, sex, and symptom characteristics; older Diamond-Forrester approaches overestimate obstructive CAD in contemporary populations. Noninvasive testing is most beneficial when pretest probability exceeds 15%; testing may be considered at lower probability when clinical judgment supports it. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Stable anginal features are constricting chest, neck, shoulder, jaw, or arm discomfort precipitated by exertion and relieved by rest or nitroglycerin. Two of three features represent atypical angina and one or none represent nonanginal pain, but symptom labels should not override risk factors, evolving symptoms, or clinician concern. BMJ+1BMJAngina: contemporary diagnosis and managementnice org ukRecent-onset chest pain of suspected cardiac origin ...
For low-risk stable chest pain, defer urgent testing when clinical probability is low. Coronary artery calcium testing can help identify a low-risk group when CAC is zero, and exercise ECG without imaging is a reasonable option when the patient can exercise and the resting ECG is interpretable. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
CCTA is generally preferable in patients younger than 65 years and those not already receiving optimal preventive therapy because it defines plaque burden and stenosis. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Stress imaging is often favored in patients 65 years or older, those with greater likelihood of ischemia, known extensive plaque, uninterpretable resting ECG, or inability to exercise adequately. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
CCTA is limited by iodinated contrast allergy, renal impairment per local protocol, inability to cooperate with breath-holding, elevated or irregular heart rate, and contraindications to heart-rate control or nitroglycerin. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Stress imaging options include stress echocardiography, PET or SPECT myocardial perfusion imaging, and stress CMR; PET provides better diagnostic and prognostic performance than SPECT when available. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
When to escalate after initial testing
For an intermediate coronary stenosis on CCTA, FFR-CT can provide lesion-specific ischemia assessment, particularly for 40% to 90% proximal or mid-coronary stenoses. Patients with high-risk CAD anatomy, including left main stenosis of at least 50% or anatomically significant three-vessel disease, require invasive evaluation and guideline-directed management. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
If stable symptoms persist despite nonobstructive coronary findings or a negative anatomic test, do not dismiss ischemia. Consider INOCA, especially in women and patients with hypertension or diabetes. PET myocardial blood-flow reserve, stress CMR blood-flow reserve, stress echocardiographic coronary flow velocity reserve, or invasive coronary function testing can identify microvascular dysfunction or vasomotor abnormalities. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
A CCTA-first strategy in stable chest pain referred for invasive angiography produced similar 3.5-year MACE compared with direct invasive angiography but fewer major procedure-related complications. NEJMNEJMCT or Invasive Coronary Angiography in Stable Chest Pain
In the DISCHARGE trial, major procedure-related complications occurred in 0.5% with initial CT versus 1.9% with initial invasive angiography. NEJMNEJMCT or Invasive Coronary Angiography in Stable Chest Pain
Known coronary disease
Optimize medical therapy and use testing to direct revascularization decisions
Symptoms, ischemic burden, anatomy, and patient goals determine escalation.
For stable chest pain with known CAD, first assess whether preventive and anti-ischemic therapy can be intensified. In patients with frequent symptoms despite guideline-directed therapy, severe stress-induced ischemia, high-risk anatomy, or new high-risk clinical findings, invasive angiography may be appropriate if revascularization is consistent with patient goals. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Invasive physiologic assessment should guide revascularization of intermediate lesions. FFR of 0.80 or less or instantaneous wave-free ratio of 0.89 or less identifies lesion-specific ischemia used to guide PCI. BMJ+2BMJAngina: contemporary diagnosis and managementAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ... In stable CAD, an initial invasive strategy does not reduce the composite primary MACE endpoint compared with a conservative strategy in the ISCHEMIA trial, but patients with frequent angina experienced more prompt and durable symptom improvement with invasive management. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
For prior CABG with stable symptoms, stress imaging helps localize ischemia; CCTA is useful for graft patency but may be less reliable for native-vessel stenosis. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
For known nonobstructive CAD, CCTA can identify progression, new obstructive stenosis, and high-risk plaque features, while stress imaging evaluates ischemic burden. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Nonobstructive CAD is clinically meaningful: in PROMISE, it was associated with approximately threefold higher MACE risk over about two years. AHA JournalsAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
Common questions
Can a normal ECG exclude acute coronary syndrome?
No. A normal or unchanged initial ECG does not exclude ACS. Repeat ECGs are indicated when symptoms persist, recur, or clinical concern remains, and serial hs-cTn testing should be interpreted in an assay-specific pathway. AHA Journals+2AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...AHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
When can a single high-sensitivity troponin rule out MI?
A single hs-cTn strategy is limited to patients with symptom onset at least 3 hours before testing and a result below the applicable assay-specific low threshold. Otherwise, use serial testing and delta interpretation. AHA Journals+2AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...AHA Journals2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...
Does relief with nitroglycerin prove ischemic chest pain?
No. Nitroglycerin response is not diagnostic of myocardial ischemia and should not be used to distinguish cardiac from esophageal or other chest pain. AHA Journals+2AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...nice org ukRecent-onset chest pain of suspected cardiac origin ...
Which stable chest pain patients need CCTA versus stress imaging?
For intermediate-high pretest probability, CCTA is generally favored in younger patients and when plaque characterization changes prevention decisions; stress imaging is often favored in older patients or those with higher ischemia likelihood, extensive calcification, uninterpretable ECG, or limited CCTA feasibility. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
What should be considered after angina symptoms with nonobstructive coronary arteries?
Consider INOCA, including microvascular dysfunction and vasomotor disorders. PET or CMR flow-reserve assessment, stress echocardiographic coronary flow velocity reserve, or invasive coronary function testing may establish an actionable endotype. AHA Journals+1AHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesAHA Journals2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR ...
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