Algorithm for Evaluating a Patient with Chest Pain

Questions

When to Execute:

(1) Are the patient's symptoms stable?

starting question

(2) Is a myocardial stress test (gated-SPECT, MRI or PET) normal?

if (1) Yes

(3) Is coronary angiography normal?

if (1) Yes AND (2) No; OR if (1) No

(4) Is coronary vascular function normal?

if (1) Yes AND (2) No AND (3) Yes; OR if (1) No AND (3) Yes

Question 1

Question 2

Question 3

Question 4

Management Strategy

Yes

Yes

NA

NA

A

Yes

No

No

NA

C

Yes

No

Yes

Yes

A

Yes

No

Yes

No

B

No

NA

Yes

Yes

A

No

NA

Yes

No

B

No

NA

No

NA

C

Management Strategy

Actions

A

evaluate for nonischemic cardiac and noncardiac causes of chest pain; consider tricyclic antidepressant therapy; manage cardiac risk factors

B

aggressive medical and symptom management (aspirin, beta-blockers, statins, ACE inhibitors, tricyclic antidepressants, exercise training)

C

medical management; consider coronary artery revascularization