Patients presenting with acute pain in the chest: Myocardial infarction or harmless neuralgia?

Autor: Prof. Dr. med. Uwe Zeymer

A patient suffering extreme chest pain is brought to your office. Is it an infarction? A lung embolism? Or just “neuralgia”? Does the patient need to be taken by ambulance to the catheter suite or can you cancel his emergency status? Our CME courses show how to set the right course even in tense situations. (…)


The most important diagnostics to be performed on patients with acute chest pain is to immediately take a 12-lead ECG. This will demonstrate or rule out any ST elevation infarction (Fig.). Also, any previously unknown left branch block in the presence of the typical symptoms mandates immediate admission to a hospital. Whereas ST segment depressions, especially when showing a dynamic pattern on multiple ECG recordings, are highly suggestive of an ischemic origin;
T-negativity is not necessarily associated with coronary causes. On the other hand, coronary causes cannot be ruled out just because the ECG is completely normal.

Cardiogoniometry is a new non-invasive method for diagnosing acute coronary syndrome. This vector ECG with computer-supported evaluation can detect coronary ischemia early. The method is especially useful when the ECG produces inconclusive results. Immediate admission to the hospital can be considered as one alternative if the clinical findings continue to support a high-grade suspicion of acute coronary syndrome, even if the ECG is normal or the changes in the ECG are non-specific; another alter¬native is to perform a troponin quick test. Since in the majority of cases, however, troponin does not become positive until four to six hours after the initial manifestation of the symptoms, a negative finding soon after the initial symptoms appear is not sufficient for ruling out an acute coronary syndrome. (…)

Original Source:
MMW-Fortschritte der Medizin
2011, 153