Chest pain diagnosis

Johnson TR, Nikolaou K, Fink C, Becker A, Knez A, Rist C, Reiser MF, Becker CR (2007) [Dual-source CT in chest pain diagnosis). Radiologe 47 301-309... 

A 47-year-old female comes to the emergency department (ED) with severe crushing chest pain of one hour s duration Electrocardiogram and blood chemistries are consistent with a diagnosis of acute ME Streptokinase is chosen as part of the therapeutic regimen. What is its mechanism of action ... 

Storrow AB, Gibler WB. Chest pain centers Diagnosis of acute coronary syndromes. Ann Emerg Med 2000 35 449-461. 

Although troponin elevation suggests necrosis, biomarkers of myocardial ischemia are equally important. Ischemia-modified albumin was reported to be highly sensitive for a diagnosis of ischemia in patients with chest pain presenting to the emergency room (12). Further study needs to be done on this sensitive biomarker for myocardial ischemia. 

Important aspects of the clinical history include the nature or quality of the chest pain, precipitating factors, duration, pain radiation, and the response to nitroglycerin or rest. There appears to be little relationship between the historical features of angina and the severity or extent of coronary artery vessel involvement. Ischemic chest pain may resemble pain arising from a variety of noncardiac sources, and the differential diagnosis of anginal pain from other etiologies may be difficult based on history alone. 

Dicobalt edetate. Cobalt forms stable, nontoxic complexes with cyanide. It is toxic (especially if the wrong diagnosis is made and no cyanide is present), causing hypertension, tachycardia and chest pain consequent cobalt poisoning is treated by giving sodium calcium edetate and i.v. glucose. 

Transient relief of pain due to spasm of other smooth muscle (colic), can sometimes be obtained, so that relief of chest pain by nitrates does not prove the diagnosis of angina pectoris. 

Myocardial ischemia has also been reported in susceptible patients. A Japanese group carried out dobutamine stress echocardiography in 51 patients with a presumptive diagnosis of variant angina (17). All had coronary vasospasm in response to intracoronary acetylcholine and seven also had chest pain and reversible ST segment elevation. One must incidentally wonder whether this procedure was entirely advisable. 

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