Classification of<unk> s. Electrocardiogram In the setting of acute chest pain, the electrocardiogram is the investigation that most reliably distinguishes between various causes. The ECG should be done as early as practicable, including in the ambulance if possible. If this indicates acute heart damage (elevation in the ST segment, new left bundle branch block), treatment for a heart attack in the form of angioplasty or thrombolysis is indicated immediately (see below). In the absence of such changes, it is not possible to immediately distinguish between unstable angina and NSTEMI. Imaging and blood tests As it is only one of the many potential causes of chest pain, the patient usually has a number of tests in the emergency department, such as a chest X-ray, blood tests (including myocardial markers such as troponin I or T, and H-FABP and/or a D-dimer if a pulmonary embolism is suspected), and telemetry (monitoring of the heart rhythm). Combination of troponin levels (less than 5 ng/l) with low TIMI scores can help to predict those with low possibility of myocardial infarction and discharge them safely from the emergency department.<unk>  CT angiography combined with Troponin levels is also helpful to triage those who are susceptible to<unk> . F-fluoride positron emission tomography is also helpful in identifying those with high risk, lipid-rich<unk>  plaques. Prediction scores The ACI-TIPI score can be used to aid diagnosis; using seven variables from the admission record, this score predicts crudely which patients are likely to have myocardial ischemia. For example, according to a randomized controlled trial, males having chest pain with normal or non-diagnostic ECG are at higher risk for having<unk>  than women. In this study, the sensitivity was 65.2% and specificity was 44%. This particular study had an 8.4% prevalence of<unk> , which means the positive predictive value of being a male with chest pain and having<unk>  syndrome is 9.6% and negative predictive value is 93.2% ( click here to adjust these results for people at higher or lower risk of<unk> . In a second cohort study, exercise electrocardiography was similarly found to be a poor predictor of<unk>  at follow-up. Of the patients who had a<unk>  event at 6 years of follow up, 47% had a negative ECG at the start of the study. With an average follow up of 2.21 years the receiver operating characteristic curves gave resting ECG a score of 0.72 and exercise ECG a score of 0.74. There are not only prediction scores for diagnosis of<unk> , but also prognosis. Most notably, the GRACE<unk>  Risk and Mortality score helps diagnose, and based upon that score predicts mortality rate of a given patient. It takes into account both clinical (blood pressure, heart rate, EKG findings) and medical history in its scoring system.
Acute coronary syndrome
Costochondritis
Acute chest syndrome
Bornholm disease
Wooden chest syndrome
Digoxin toxicity
Acute pericarditis
Unstable angina