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Patient handout

Undifferentiated chest pain (ED)

PRODUCTION

1. Your condition

This handout is for undifferentiated chest pain (ed). Your care team identified this based on: acute chest pain presenting to ed (aha/acc 2021 class i — ecg within 10 min).

Other reasons your team may use this plan: chest pressure radiating to jaw / arm / back ± diaphoresis ± nausea (gulati 2021); tearing chest / interscapular pain — dissection suspicion (aha 2022 acute aortic disease); sharp pleuritic chest pain ± dyspnea — pe / pericarditis / ptx suspicion (esc 2019 pe).

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

  • ST-elevation ≥1 mm in 2 contiguous leads OR new LBBB with ACS symptoms on 12-lead ECG (AHA/ACC 2021 Class I)(life-threatening)
  • Tearing chest / interscapular pain + BP differential >20 mmHg between arms OR widened mediastinum on CXR OR neurologic deficit + chest pain (AHA 2022 Acute Aortic Disease)(life-threatening)
  • Suspected PE + sustained hypotension (SBP <90 ×≥15 min) OR cardiac arrest with PEA / pulseless rhythm (ESC 2019 PE)(life-threatening)
  • Tracheal deviation + decreased breath sounds + hyperresonance + hemodynamic compromise — bedside diagnosis, do NOT delay for imaging (ATS/CHEST 2010)(life-threatening)
  • Beck triad (hypotension + muffled heart sounds + JVD) + pericardial effusion on POCUS + pulsus paradoxus >10 mmHg (AHA 2021; ESC 2015 Pericardial Disease)(life-threatening)
  • Hs-cTn dynamic rise/fall >20% over 1-3 h (Δ-positive) OR new ischemic ECG changes (ST-depression / T-inversion) during observation (Reichlin 2009; Thygesen 2018)
  • SBP <90 OR HR >120 OR oxygen level (SpO₂) <90% on room air with ongoing chest pain (Gulati 2021)

5. Follow-up

If discharged low-risk: PCP / cardiology within 72 h; return precautions (chest pain recurrence, dyspnea, syncope, new neurology); ASCVD risk factor counseling; smoking cessation; outpatient lipid panel deferred (Gulati 2021; 2026 ACC/AHA Lipid; 2025 AHA/ACC HTN)

6. Sources

Guideline: 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Chest Pain Guideline (Gulati JACC 2021) + ESC 2020 NSTE-ACS + 2025 AHA/ACC HTN + 2026 ACC/AHA Lipid + ESC 2019 PE + AHA 2022 Acute Aortic Disease + ATS/CHEST 2010 Pneumothorax

  1. pubmed.ncbi.nlm.nih.gov/11874776
  2. pubmed.ncbi.nlm.nih.gov/20603345
  3. pubmed.ncbi.nlm.nih.gov/23465250