Background: Chest pain and related symptoms are the number two reason patients visit emergency departments in the United States, often leading to routine hospitalization or observation. Improving utilization management of patients presenting to the emergency department with chest pain is an important goal for hospitals. Use of 5th generation troponins and risk stratifying tools can [...]

Background: Unstable Angina (UA) is a common subset of Acute Coronary Syndrome (ACS) and presents as atypical chest pain without the presence of cardiac biomarkers. It accounts for nearly 550,000 hospital admissions each year in the United States [1]. Management of UA can vary depending on the physician and/or intensity of symptoms. Prior studies have [...]

Background: Epipericardial fat necrosis (EFN) presents as acute chest pain with the potential to mimic life-threatening conditions. It is unclear whether this is truly a rare condition, or simply underdiagnosed by low threshold of suspicion. The literature suggests an estimated prevalence of 2% of EFN as the cause of chest pain in all patients presenting [...]

Background: Recent literature supports risk stratifying patients presenting to the Emergency Department (ED) with undifferentiated chest pain based upon the HEART score. Our institution utilizes the HEART score in a chest pain pathway. Patients with scores of 0 to 3 are typically discharged home after two negative troponins while those with intermediate scores of 4 [...]

Background: Chest pain accounts for 2-5% of all Emergency Room (ER) visits. Tools like TIMI score and HEART score exist to risk stratify patients, but a low threshold for admission has been traditional because the risk of inadvertent discharge of patients with true ACS. In this study, we evaluate the yield of myocardial perfusion scan [...]

Background: Coronary Computed Tomography Angiography (CCTA) is a common anatomic modality for detection of cardiac ischemia in the setting of chest pain hospitalizations. However, invasive coronary angiography (ICA) is the gold standard for diagnosing ischemic coronary artery disease. Research showed that CCTA has a high sensitivity but lacks the specificity and accuracy component of Fractional [...]

Case Presentation: A 15 year old female with a history of severe persistent asthma, allergic rhinitis, and eczema presented with a two day history of cough, shortness of breath, and chest pain. She was diagnosed with asthma at age 13 and had eight presumed exacerbations and five diagnoses of pneumonia since that time. She was [...]

Case Presentation: A 50 year old male with no past medical history presented with severe chest pain that progressively worsened over 2 days. His chest pain was described as left sided, non-radiating, and constant. He reported sore throat, headaches, and subjective fevers for the past 5 days. The patient also reported multiple family members received [...]

Case Presentation: A 36 year old female with a past medical history of hypothyroidism, type two diabetes, asthma, polycystic ovarian syndrome, and bipolar disorder presents with sharp chest pain that radiates to her left neck and arm. She states that the pain started suddenly when she was sitting 10 hours ago and gets worse with [...]

Case Presentation: 19-Year-old ,African American, female with significant medical history of hypertension, Uncontrolled Diabetes Mellitus, presents with chest pain for 24 hr. Pain was sub-sternal, pressure like,7/10,radiating to right arm and in between the shoulder blades, persistent ,precipitated by drinking alcohol the night before ,associated with Shortness of breath and palpitations. Patient had a history [...]