cardiovascular disorders
Chest Pain
Key Points
Immediate life threats must be ruled out first. Some serious disorders, particularly coronary ischemia and pulmonary embolism, often do not have a classic presentation. Most patients should have pulse oximetry, ECG, cardiac marker measurement, and chest x-ray. Evaluation must be prompt so that patients with ST-elevation myocardial infarction or other criteria for intervention can be in the heart catheterization laboratory (or have thrombolysis) within the 90-minute standard. If PE is highly likely, antithrombin drugs should be given while the diagnosis is pursued; another embolus in a patient who is not receiving anticoagulants may be fatal. 