All patients with acute chest pain syndromes need to be evaluated for the possibility of acute coronary syndromes. Based upon the initial history, physical examination, and ECG, patients can be subdivided into those with and without known coronary artery disease. Patients with known coronary artery disease should be further subdivided into those who meet criteria for AMI (and may or may not meet criteria for reperfusion therapy), those with a stable anginal pattern that do not require acute intervention, and those with unstable angina. Patients with unstable angina should be treated according to their risk for acute myocardial infarction and death (Table IZ,-,.!).
Patients without known coronary artery disease who do not have an obvious myocardial infarction should be evaluated for their likelihood of coronary artery disease (T.a.b.!e.4.7-1.1) and the possibility of an alternative diagnosis (not ischemic heart disease). Those with a clear alternative diagnosis should be treated accordingly.
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