Bugiardini and Merz proposed a practical algorithm for evaluating a patient with chest pain. The authors are from the University of Bologna in Italy and Cedars-Sinai Medical Center in Los Angeles.
Patient selection: presence of chest pain
When to Execute:
(1) Are the patient's symptoms stable?
(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
evaluate for nonischemic cardiac and noncardiac causes of chest pain; consider tricyclic antidepressant therapy; manage cardiac risk factors
aggressive medical and symptom management (aspirin, beta-blockers, statins, ACE inhibitors, tricyclic antidepressants, exercise training)
medical management; consider coronary artery revascularization
To read more or access our algorithms and calculators, please log in or register.
Purpose: To evaluate a patient with chest pain using the algorithm of Bugiardini and Merz.
Objective: clinical diagnosis, including family history for genetics, differential diagnosis and mimics, red flags, complication detection
ICD-10: R07.3, R07.4,