Admit
Ischemic ECG changes
Pacemakers
LBBB
Positive troponins
Abnormal vital signs
ACC/AHA rec need for provocative testing withing 72 hrs, consider admitting
For low risk (HEART) pts, may be better off discharge home with follow up
Risk of MACE after neg ED work up 1/2422 vs Risk of preventable adverse event in hospital is 1/164
Ischemic ECG changes
Pacemakers
LBBB
Positive troponins
Abnormal vital signs
Risk of MACE after neg ED work up 1/2422 vs Risk of preventable adverse event in hospital is 1/164
ACS - Stress Testing
Acute coronary syndrome 
Acute coronary syndromes 
Acute chest syndrome
STEMI
Unstable angina
Non-STEMI
ST-segment elevation myocardial infarction
Takotsubo cardiomyopathy