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Acute chest pain and coronary syndromes 

Acute chest pain and coronary syndromes
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date: 18 February 2020

Differentiating life-threatening from benign causes of chest pain in the critical care setting is a challenge when the symptoms and signs overlap, and patients are unable to communicate fully. A high index of suspicion is required for occult disease. Once the clinician has ensured the patient is haemodynamically stable, it is imperative to rule out myocardial infarction in the first instance. Where possible, a thorough history and a full examination should be undertaken. Electrocardiogram, chest X-ray, and routine observations are often diagnostic. Targeted investigation such as computed tomography, or transthoracic or transoesophageal ultrasonography may be required to confirm these diagnoses. Timely intervention optimizes survival benefit. Treatment may be necessary prior to confirmation of diagnosis, based on high clinical suspicion and risk scoring. Other causes of chest pain should be considered once the immediately life-threatening conditions are excluded.

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