Dr. Mattu reviews an Accelerated Diagnostic Protocol for Chest Pain based on the guidelines of the American Heart Association. This is an important topic for all Emergency Physicians and presented gratis by EM:RAP. Feel free to share this special medico-legal content with your colleagues for discussion.
Brooks W. - August 7, 2015 6:50 PM
This is almost archeologically old, but hey.
Looking at the 2014 AHA NSTEMI guidelines (page e156), it seems like the recommendation to get a treadmill/ MPI/stress echo/CCTA is not mandated. They instead classify these tests as IIa recommendations, stating specifically that "it is reasonable" to pursue these tests. Not obligatory.
They comment that "Some protocols also call for a functional or anatomic test" after testing with troponins. That isn't very strong language! So the situation doesn't seem as perilous from a risk management perspective as you portrayed.
Pity I didn't start reading up on this until after #smaccUS - it would have been great to talk about this in person!
Thanks for all your cardiac education. You and Ken Grauer were the cornerstones of my early ECG indoctrination.
Elizabeth S., M.D. - January 16, 2016 1:36 PM
Where can I find the 'shared decision making' graphic described here. It says in the blog-post...Where is that?
Connor N. - December 30, 2016 3:19 PM
Ditto Elizabeth S. Comment...where is the blog post???
Adam B. - February 20, 2017 10:06 AM
Looks like the shared decision making graphic as well as an evaluation and dispo guideline can be found here. https://blog.essentialsofem.com/2015/02/17/emrap-special-edition-a-defensible-chest-pain-adp/