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Chest pain is one of the most common reasons that people seek medical care. This guideline was developed for the evaluation of acute or stable chest pain in outpatient and emergency department settings, emphasizing the diagnosis of chest pain with an ischemic etiology. The following are key guideline perspectives:
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3/4/22, 9:26 PM
2021 AHA/ACC Chest Pain Guideline Perspectives – American College of Cardiology
2021 AHA/ACC Chest Pain Guideline
Perspectives
Oct 28, 2021 | David S. Bach, MD, FACC
Authors:
Gulati M, Levy PD, Mukherjee D, et al.
Citation:
2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR
Guideline for the Evaluation and Diagnosis of
Chest Pain: A Report of the American College of
Cardiology/American Heart Association Joint
Committee on Clinical Practice Guidelines. J Am
Coll Cardiol 2021;Oct 28:[Epub ahead of print].
https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/10/27/14/06/2021-guideline-for-chest-pain-gl_chestpain
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3/4/22, 9:26 PM
2021 AHA/ACC Chest Pain Guideline Perspectives – American College of Cardiology
Chest pain is one of the most common reasons that people seek medical care. This
guideline was developed for the evaluation of acute or stable chest pain in
outpatient and emergency department settings, emphasizing the diagnosis of chest
pain with an ischemic etiology. The following are key guideline perspectives:
1. Acute chest pain refers to symptoms of new onset or change from previous in
pattern, intensity, or duration; stable chest pain refers to symptoms that are
chronic and associated with consistent precipitants. Although the term ‘chest
pain’ is used in clinical practice, patients often report pressure, tightness,
squeezing, heaviness, or burning in locations in addition to the chest, including
the shoulder, arm, neck, upper abdomen, or jaw. Chest pain should be
described as cardiac, possibly cardiac, or noncardiac rather than as typical or
atypical.
2. Chest pain is the most common symptom among both men and women
diagnosed with acute coronary syndrome (ACS). However, women more
commonly have accompanying symptoms including nausea, palpitations, and
shortness of breath.
3. Efforts should be made to expedite the evaluation of patients with acute chest
pain, including patient education to call 9-1-1 for emergency medical services
transportation to the nearest emergency department.
https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/10/27/14/06/2021-guideline-for-chest-pain-gl_chestpain
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2021 AHA/ACC Chest Pain Guideline Perspectives – American College of Cardiology
4. Electrocardiography (ECG) is important in the evaluation of both acute and
stable chest pain to assess for evidence of ACS.
5. Owing to high sensitivity and specificity for myocardial tissue, serial assessment
of cardiac troponin (cTn) I or T is the preferred biomarker for the assessment of
myocardial injury among patients with acute chest pain; high-sensitivity cTn is
preferred because it allows rapid detection of myocardial injury and has
increased diagnostic accuracy.
6. 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 (CDPs) should be
used routinely in the emergency department and in outpatient settings.
7. Clinically stable patients evaluated for chest pain should be included in clinical
decision making, weighing information about costs, risks of adverse events,
radiation exposure, and alternative options.
8. CDPs for patients with acute chest pain:
Among patients with acute chest pain and low cardiovascular risk (30-day risk
of death or major adverse cardiac events [MACE]
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