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Guideline Addresses Diagnosis, Evaluation of Chest Pain in Adults

Last Updated: November 02, 2021.

TUESDAY, Nov. 2, 2021 (HealthDay News) -- Chest pain or discomfort can extend beyond the chest, and patients experiencing this pain should seek medical care immediately, according to a clinical practice guideline issued by the American Heart Association and American College of Cardiology and published online Oct. 28 in Circulation and the Journal of the American College of Cardiology.

Martha Gulati, M.D., from the University of Arizona in Phoenix, and colleagues conducted a comprehensive literature review to develop recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.

The researchers note that angina equivalents include pain, pressure, tightness, or discomfort in the chest, shoulders, arms, neck, back, upper abdomen, or jaw, as well as shortness of breath and fatigue. Patients with acute chest pain or chest pain-equivalent symptoms should immediately seek medical care. Women are more likely to present with accompanying symptoms of acute coronary syndrome, including nausea and shortness of breath, although chest pain is the most dominant and frequent symptom for men and women. For establishing a biomarker diagnosis of acute myocardial infarction, high-sensitivity cardiac troponins are the preferred standard. Urgent diagnostic testing for suspected coronary artery disease is not needed for patients with acute or stable chest pain determined to be low risk. Routine use of clinical decision pathways for chest pain in the emergency department and outpatient setting is recommended. Cardiac imaging and testing are more beneficial for patients with acute or stable chest pain who are at intermediate risk or intermediate-to-high-risk for obstructive coronary artery disease.

"The guideline emphasizes the tests that may be most appropriate, depending on the individual situation, and which ones won't provide additional information," Gulati said in a statement.

Several authors and reviewers disclosed financial ties to the pharmaceutical and medical device industries.

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