Causes
Clinical
features
Investigations
Therapy
Prognosis
|  | | | Clinical
features |
Ask about
the pain: specifically
its duration a
b
c
Why?
-
Chest pain, which began 48 hours or more ago makes a myocardial infarction more likely.
a
Episodes of chest pain for over 1 year makes coronary artery disease more likely
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
Post-test Probability |
LR-
(95% CI)
|
Post-test Probability |
intermittent chest pain referred for investigation
c
(pre-test probability: 67%)
|
coronary artery disease
(angiography and exercise test)
|
chest pain for over 1 year
|
infinity
(3.5 to
infinity)
|
100% |
0.37
(0.23 to
0.59)
|
43% |
Constant pain makes a myocardial infarction more likely
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
Post-test Probability |
LR-
(95% CI)
|
Post-test Probability |
anterior chest pain
b
(pre-test probability: 12%)
|
myocardial infarction
(cardiac enzymes, ECG)
|
constant pain
|
1.7
(1.3 to
2.1)
|
19% |
0.58
(0.41 to
0.82)
|
8% |
Symptoms lasting longer than 24 hours makes aortic dissection slightly less likely
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
Post-test Probability |
LR-
(95% CI)
|
Post-test Probability |
suspected aortic dissection undergoing angiography
c
(pre-test probability: 1%)
|
aortic dissection
(angiography, surgery or autopsy)
|
symptoms for < 24 hours
|
1.5
(1.2 to
2.0)
|
1.5% |
0.42
(0.27 to
0.67)
|
0.42% |
|
internal medicine