Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Cardiology-CTVS
  • Cardiology & CTVS Guidelines
  • Evaluation and...

Evaluation and diagnosis of chest pain- ACC, AHA publish first guideline

Written By : Dr Kartikeya Kohli |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-11-02T09:15:09+05:30  |  Updated On 2 Nov 2021 9:15 AM IST
Evaluation and diagnosis of chest pain- ACC, AHA publish first guideline
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

American Heart Association (AHA) and American College of Cardiology (ACC) have released a joint clinical practice guideline on evaluation and diagnosis of chest pain. The guidelines provide recommendations and algorithms for conducting initial assessments, general considerations for cardiac testing, choosing the right pathway for patients with acute chest pain, and evaluating patients with stable chest pain.

It is an evidence-based approach to evaluating patients that will assist clinicians who manage, diagnose, and treat patients who experience chest pain.

The guideline has been prepared on behalf of and approved by the AHA and ACC Joint Committee on Clinical Practice Guidelines. In addition to this five other partnering organizations also participated in and approved the guideline namely the American Society of Echocardiography (ASE), the American College of Chest Physicians (CHEST), the Society for Academic Emergency Medicine (SAEM), the Society of Cardiovascular Computed Tomography (SCCT), and the Society for Cardiovascular Magnetic Resonance (SCMR).

The guideline has been simultaneously published online October 28 in Circulation and the Journal of the American College of Cardiology.

According to the guidelines, chest pain is the second most common cause of ED admission in the U.S., behind injury, and accounts for more than 6.5 million ED presentations or approximately 4.7% of all ED visits.The guideline has been developed for the evaluation of acute or stable chest pain in outpatient as well as in emergency department emphasizing the diagnosis of chest pain with an ischemic etiology. The following are key points to remember.

1.Chest pain is the most common symptom among both men and women diagnosed with acute coronary syndrome (ACS)Chest Pain includes Pain, pressure, tightness, or discomfort in the chest, shoulders, arms, neck, back, upper abdomen, or jaw, as well as shortness of breath and fatigue should all be considered anginal equivalents.

Women more commonly have accompanying symptoms including nausea, palpitations, and shortness of breath.

2. Electrocardiography (ECG) is important in the evaluation of both acute and stable chest pain to assess for evidence of ACS.

3.High-Sensitivity Troponins is Preferred test as it allows rapid detection of myocardial injury and has increased diagnostic accuracy.

High-sensitivity cardiac troponins are the preferred standard for establishing a biomarker diagnosis of acute myocardial infarction, allowing for more accurate detection and exclusion of myocardial injury.

4.Early Care for Acute Symptoms. Patients with acute chest pain or chest pain equivalent symptoms should seek immediate medical care. Although most patients will not have a cardiac cause, the evaluation of all patients should focus on the early identification or exclusion of life-threatening causes.

5.Share the Decision-Making. Clinically stable patients presenting with chest pain should be included in decision-making; information about risk of adverse events, radiation exposure, costs, and alternative options should be provided to facilitate the discussion.

6.Testing Not Needed Routinely for Low-Risk Patients. For patients with acute or stable chest pain determined to be low risk, urgent diagnostic testing for suspected coronary artery disease is not needed.The guideline authors emphasize there are opportunities to reduce unnecessary or inappropriate testing for some adults with chest pain, especially in the emergency department and for those patients screened as low risk for a cardiac event.

7.Pathways.Among patients with acute or with stable chest pain, the use of diagnostic testing should be based on a structured assessment of cardiac risk and targeted to patients most likely to benefit.Clinical decision pathways for chest pain in the emergency department and outpatient settings should be used routinely.

8.Accompanying Symptoms. Chest pain is the dominant and most frequent symptom for both men and women ultimately diagnosed with acute coronary syndrome. Women may be more likely to present with accompanying symptoms such as nausea and shortness of breath.

9.Identify Patients Most Likely to Benefit From Further Testing. Patients with acute or stable chest pain who are at intermediate risk or intermediate to high pre-test risk of obstructive coronary artery disease, respectively, will benefit the most from cardiac imaging and testing.

10.Noncardiac Is In. Atypical Is Out. "Noncardiac" should be used if heart disease is not suspected. "Atypical" is a misleading descriptor of chest pain, and its use is discouraged.

11.Structured Risk Assessment Should Be Used. For patients presenting with acute or stable chest pain, risk for coronary artery disease and adverse events should be estimated using evidence-based diagnostic protocols.

Clinical decision pathways for patients with acute chest pain:
A.In patients with acute chest pain and low cardiovascular risk, no additional urgent cardiac testing may be needed.
B In patients with acute chest pain at intermediate risk and no known CAD, additional testing can include exercise ECG, stress echocardiography, stress nuclear myocardial perfusion imaging, or stress CMRI or anatomic testing like CCTA.
C.Among patients with known CAD and acute chest pain at intermediate risk, additional testing can include functional testing or CCTA in the setting of nonobstructive CAD; functional testing in the setting of known obstructive CAD; or invasive coronary angiography (ICA) in the setting of known left main disease, proximal vessel CAD, or multivessel CAD.
D Patients with acute chest pain and high risk (new ischemic changes on ECG, cTn-confirmed myocardial injury, new left ventricular systolic dysfunction, new moderate-severe ischemia on functional testing, hemodynamic instability, or a high-risk CDP score) should undergo ICA.
E.Nonischemic cardiac causes of acute chest pain include acute aortic syndrome (evaluable with CTA), acute pulmonary embolus (PE; evaluable with PE-protocol CTA), myopericarditis (evaluable with CMR), and valve disease (evaluable with echocardiography).
Clinical decision pathways for patients with stable chest pain:
A.In patients having stable chest pain and no known CAD, patients at low probability of obstructive CAD and a favorable prognosis can be identified using a pretest probability model that incorporates age, sex, and presenting symptoms; among these patients, additional diagnostic testing can be deferred. Coronary artery calcium testing can be used as a first-line test to exclude calcific plaque.
B. In patients who are at intermediate-high risk with stable chest pain and no known CAD, CCTA is useful for the diagnosis and for risk stratification of CAD. Further stress imaging (echocardiography, MPI, or CMR) is useful for the diagnosis of ischemia and for estimating the risk of MACE.
C.In patients known to have obstructive CAD and stable chest pain despite guideline-directed medical therapy (GDMT), stress imaging (MPI, CMR, or echocardiography) is recommended for the diagnosis of ischemia and assessment of risk. Patients at high risk or those with moderate-severe ischemia should undergo ICA.
D. In patients with known nonobstructive CAD and stable chest pain despite GDMT, C CTA or stress testing is reasonable.

According to Chair of the guideline writing group Dr. Martha Gulati, MD, MS, FACC, FAHA, a professor of cardiology and former academic division chief of the division of cardiology at the University of Arizona in Phoenix, "this standard approach provides clinicians with the guidance to better evaluate patients with chest pain, identify patients who may be having a cardiac emergency and then select the right test or treatment for the right patient."

For further reference log on to: Gulati M, et al. Circulation. 2021;doi:10.1161/CIR.0000000000001029.


Acute Coronary SyndromeStableBiomarkersCardiac Imaging TechniquesChest PainCoronary AngiographyEchocardiographyStressElectrocardiographyGuidelinesACCAHAChest pain-
Dr Kartikeya Kohli
Dr Kartikeya Kohli

    Dr Kartikeya Kohli is an Internal Medicine Consultant at Sitaram Bhartia Hospital in Delhi with super speciality training in Nephrology. He has worked with various eminent hospitals like Indraprastha Apollo Hospital, Sir Gangaram Hospital. He holds an MBBS from Kasturba Medical College Manipal, DNB Internal Medicine, Post Graduate Diploma in Clinical Research and Business Development, Fellow DNB Nephrology, MRCP and ECFMG Certification. He has been closely associated with India Medical Association South Delhi Branch and Delhi Medical Association and has been organising continuing medical education programs on their behalf from time to time. Further he has been contributing medical articles for their newsletters as well. He is also associated with electronic media and TV for conduction and presentation of health programs. He has been associated with Medical Dialogues for last 3 years and contributing articles on regular basis.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

    Show Full Article
    Next Story

    Editorial

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

    Aspirin in Primary Prevention- When to Consider?

    Aspirin in Primary Prevention- When to Consider?

    Featured image representing medico legal

    What's the Role of Expert Opinion in Medical Negligence?

    7- Point Discharge Protocol for AECOPD: Time to Inculcate in Practice

    7- Point Discharge Protocol for AECOPD: Time to Inculcate in Practice

    Aspirin Use in Women Aged 40-50 with Diabetes and Hypertension: Identifying the Ideal Candidates

    Aspirin Use in Women Aged 40-50 with Diabetes and Hypertension: Identifying the Ideal Candidates

    View All

    Journal Club Today

    High Blood Pressure in Children Tied to Mothers Pregnancy Health: NIH Study Finds

    High Blood Pressure in Children Tied to Mother's Pregnancy Health: NIH Study Finds

    View All

    Health News Today

    Health Bulletin 10/ May/ 2025

    Health Bulletin 10/ May/ 2025

    View All
    © 2022 All Rights Reserved.
    Powered By: Hocalwire
    X
    We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok