Chest Pain and Emergency Medicine: Presentation and Risk Stratification

by John Bielinski Jr, MS, PA-C

In emergency medicine, acute myocardial infarction (or cardiac ischemia) is the number one killer of men and woman in the United States.  Coronary artery disease can present in multiple different ways.  You can have someone present that is so ill that no one would miss the diagnosis. They are ashen gray, writhing around with chest pain, and are sweaty, looking like they are knocking on death’s door. No one can miss that diagnosis.  I call that “janitor sign,” meaning the patients are so ill, that if the janitor walk into the room, the janitor would say, “you better get in here, this guys having a heart attack!”  But, on the other side of the coin, you can also have someone who presents with indigestion.  There are patients that are so grossly atypical for a presentation of an acute coronary syndrome that they are easily misdiagnosed.  I have seen it way too many times in my career, these patients with an atypical, non-text book like presentation. I now know you have to entertain an acute coronary syndrome in anybody with chest symptoms, be it chest pain, shortness of breath or indigestion.  The key is to stack the deck with cardiac risk factors.  The cardiac risk factors (or arterial risk factors) are easily recalled by the mnemonic, “SAD CHF.”   S is smoking, A is age, D is diabetes, C is cholesterol, H is hypertension and F is family history.  Don’t be burned by an ischemic cardiac presentation.  Understand the presentation can be varied, and that risk factors analysis is critical.

 

See John Bielinski Jr, MS, PA-C speak this summer at the GAPA 2018 Summer Conference in Sandestin, FL.

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