Triage of Chest Pain Patients

Patients presenting to the emergency department with acute chest pain have a long list of possible diagnoses. These include myocardial infarction, aortic dissection, and pulmonary embolism. Most of the time the imaging study can be tailored to the workup of one of these potential diagnoses. When diagnostic uncertainty exists a "triple rule-out" CTA exam can be performed to evaluate for acute MI, pulmonary embolism and aortic pathology on a single, twelve second study. The diagnostic power of this exam must be tempered by the fact that a patient receives considerably more radiation exposure using this technique.

The flow chart below indicates how Coronary CTA can be used in the emergency department in patients with chest pain. Notice that Coronary CTA has no role in patients with acute myocardial infarction (AMI) established by standard testing. Coronary CTA is utilized in patients where laboratory testing and ECG are equivocal for AMI. Because of the accuracy of Coronary CTA, a negative test allows the patient to be discharged.

Chest pain work up in the ED