Table -- Likelihood
of Ischemic Etiology and Short-Term Risk
| Part I. Chest Pain Patients Without ST-Segment
Elevation: Likelihood of Ischemic Etiology |
| |
A. High Likelihood |
B. Intermediate Likelihood |
C. Low Likelihood |
|
High likelihood that chest pain is of ischemic etiology if
patient has any of the findings in the column below: |
Intermediate likelihood that chest pain is of ischemic etiology
if patient has NO findings in column A and any of the findings in the
column below: |
Low likelihood that chest pain is of ischemic etiology if patient
has NO findings in column A or B. Patients may have any of the findings in the
column below: |
| History |
| |
|
Chief symptom
is chest or left arm pain or discomfort plus |
| |
|
Current pain
reproduces pain of previous documented angina and known CAD, including MI
|
|
| |
|
Chief symptom
is chest or left arm pain or discomfort |
| |
|
Age >70
years |
| |
|
Male sex
|
| |
|
Diabetes
mellitus |
|
| |
|
Probably
ischemic symptoms |
| |
|
Recent cocaine
use |
|
| Physical exam |
| |
|
Transient
mitral regurgitation |
| |
|
Hypotension
|
| |
|
Diaphoresis
|
| |
|
Pulmonary
edema or rales |
|
Extracardiac vascular disease |
Chest discomfort reproduced by palpation |
| ECG |
New (or presumed new) transient ST deviation (≥0.5 mm) or
T-wave inversion (≥2 mm) with symptoms |
| |
|
Fixed Q
waves |
| |
|
Abnormal ST
segments or T waves that are not new |
|
| |
|
Normal ECG
or |
| |
|
T-wave
flattening or |
| |
|
T-wave
inversion in leads with dominant R waves |
| |
|
Normal cardiac
markers |
|
| Cardiac markers |
| |
|
Elevated
troponin I or T |
| |
|
Elevated
CK-MB |
|
| |
|
Any finding
in column B above |
| |
|
PLUS
|
| |
|
Normal cardiac
markers |
|
|
| Part II. Risk of Death or Nonfatal MI Over the
Short Term in Patients With Chest Pain With High or Intermediate Likelihood of
Ischemia (Columns A and B in Part I) |
| |
High Risk |
Intermediate Risk |
Low Risk |
| |
Risk is high if patient has any of the following
findings: |
Risk is intermediate if patient has any of the following
findings: |
Risk is low if patient has NO high- or intermediate-risk
features; may have any of the following: |
| History |
Accelerating tempo of ischemic symptoms over previous 48
hours |
| |
|
Prior MI
or |
| |
|
Peripheral-artery disease
or |
| |
|
Cerebrovascular disease
or |
| |
|
CABG, previous
aspirin use |
|
|
| Character of Pain |
Prolonged, continuing (>20 min) rest pain |
| |
|
Prolonged
(>20min) rest angina is now resolved (moderate to high likelihood of
CAD) |
| |
|
Rest angina
(<20min by="by" nitrates="nitrates" or="or" relieved="relieved" rest="rest" span="span" sublingual="sublingual">
|
|
New-onset functional angina (Class III or IV) in past 2 weeks
without prolonged rest pain (but with moderate or high likelihood of
CAD) |
| Physical exam |
| |
|
Pulmonary
edema secondary to ischemia |
| |
|
New or worse
mitral regurgitation murmur |
| |
|
Hypotension,
bradycardia, tachycardia |
| |
|
S3
gallop or new or worsening rales |
| |
|
Age >75
years |
|
Age >70 years |
|
| ECG |
| |
|
Transient ST
deviation (≥0.5 mm) with rest angina |
| |
|
New or
presumably new bundle branch block |
| |
|
Sustained
VT |
|
| |
|
T-wave
inversion ≥2 mm |
| |
|
Pathologic Q
waves or T waves that are not new |
|
Normal or unchanged ECG during an episode of chest
discomfort |
| Cardiac markers |
Elevated cardiac troponin I or T |
Any of the above findings PLUS |
Normal cardiac markers |
| Elevated CK-MB |
Normal cardiac markers |
From 2005 American Heart Association Guidelines for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care, Part 8: Stabilization of the
Patient With Acute Coronary Syndromes. Circulation 112 (suppl IV) 2005.
High (A) or Intermediate (B)
Likelihood of Ischemia |
