Presents at the Emergency Department (ED) with chest pain at rest with radiation to right shoulder, lasting for about 45 min but relapsing several times during the last 24 hours, with no other symptoms.
At admission, BP is 140/90 mmHg, regular cardiac rhythm of 70 bpm, physical examination otherwise unremarkable.
Troponin I and CPK MB within normal limits.
Teaching points:
In the absence of previous MI, or in patients with no previous history of CAD, rest MPS can depict ACS with high accuracy.
Rest MPS are class IA indication for ED imaging in patiens with chest pain and nondiagnostic ECG, serum markers and enzymes, according to the ACC/AHA/ASNC Guidelines.
The use of MPS to guide admission can result in unnecessary hospitalizations and in reduction of inappropriate discharges from the ED; this is also true for patients with DM (ERASE Chest Pain Trial).
