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Clinical diagnosis of acute coronary syndrome in patients with chest pain and a normal or non-diagnostic electrocardiogram
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  • Published on:
    recognition of non-diagnostic nature of the electrocardiogram in circumflex artery occlusion

    Even though the electrocardiogram(ECG) may be entirely non- diagnostic, and entirely innocent of any ST segment deviation in as many as 38% of patients with myocardial infarction attributable to left circumflex artery occlusion(1), clinical features that simply help to confirm the diagnosis of acute coronary syndrome(ACS(2))will have greater practical value, in this context, than in patients who have diagnostic ECG. The...

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    Conflict of Interest:
    None declared.
  • Published on:
    The value of taking a history in patients with chest pain
    • Allan D Cameron, Specialist Registrar
    • Other Contributors:
      • Gerard McKay, consultant physician

    In introducing Goodacre et al's paper on low risk chest pain patients, the Primary Survey of the December 2009 issue prompts emergency physicians to reflect on "why [they] take histories at all in this patient group".(1,2) This is, in our opinion, an inappropriate reaction to the results of the study. The patients under investigation were those with a potential diagnosis of a cardiac cause of chest pain, and according t...

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    Conflict of Interest:
    None declared.