Chest Pain, Coronary Artery Disease and Emergency Medicine

Acute myocardial infarction (or cardiac ischemia) kills more men and women who come into emergency rooms than anything else. Astute ER professionals know to be on the lookout for this #1 killer, but coronary artery disease can present in multiple ways – and they’re not always easy to recognize.

Recognizing coronary artery disease
Some patients present that are so ill, no one would miss the diagnosis. They are ashen gray, writhing around with chest pain and are sweaty – basically, they look like they are knocking on death’s door. No one can miss that diagnosis. I call that the “janitor sign,” because the patients are so ill that if a janitor walks into the room, he or she would say, “You better get in here, this guy’s having a heart attack!”

Conversely, a patient with coronary artery disease could present with something as simple as indigestion. There are patients who are so grossly atypical for a presentation of an acute coronary disease that they are easily misdiagnosed. I have seen it way too many times in my career – patients with an atypical, non-text book presentation. Through experience, I now know you have to entertain acute coronary disease in anybody with chest symptoms, whether the symptoms include chest pain, shortness of breath or indigestion.

Making the right diagnosis
The key to recognizing coronary artery disease is to stack the deck with cardiac risk factors. The cardiac risk factors (or arterial risk factors) are easily recalled by the mnemonic, “SAD CHF.”

S is smoking
A is age
D is diabetes
C is cholesterol
H is hypertension
F is family history

Don’t be burned by an ischemic cardiac presentation. Understand that the presentation can be varied, and that risk factors analysis is critical.

Image courtesy of FreeDigitalPhotos.net/Vichaya Kiatying-Angsulee