Hamm and Braunwald used a simple algorithm for evaluating a patient with acute chest pain. The authors are from the Kerckhoff Heart Center in Germany and Bringham and Women's Hospital in Boston.
Parameters evaluated:
(1) ECG for ST segment elevation
(2) initial serum troponin levels
(3) time since chest pain onset
(4) repeat troponin serum levels in 4 hours (if presentation < 6 hours after onset of chest pain)
Findings
Diagnosis
positive ECG for ST segment elevation
acute MI
negative ST segment elevation, elevated initial serum troponin
unstable angina or acute MI
negative ST segment elevation, negative initial serum troponin, presentation more than 6 hours after onset of chest pain
low risk for MI, other diagnosis
negative ST segment elevation, negative initial serum troponin, presentation less than 6 hours after onset of chest pain, elevated serum troponin on repeat specimen in 4 hours
unstable angina or acute MI
negative ST segment elevation, negative initial serum troponin, presentation less than 6 hours after onset of chest pain, negative serum troponin on repeat specimen in 4 hours
low risk for MI, other diagnosis
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