Test Your Knowledge of Identifying Low-Risk Chest Pain in Urgent Care (Postscript 2 of 2)

Evidence-Based Urgent Care Postscript
Identifying Urgent Care Patients With Chest Pain Who Are at Low Risk for Acute Coronary Syndromes
November 2022

A 47-year-old male with a history of hypertension treated with lisinopril presents with dull, central chest pain that is intermittent and nonexertional. The pain has been going on for 2 days and lasts 30 minutes to an hour when it occurs. He cannot relate the pain to eating, and it is not pleuritic. His blood pressure is 142/93 mm Hg and heart rate is 77 beats/min. The remainder of his vital signs and physical examination are normal. A 12-lead ECG showed normal sinus rhythm with no ST/T-wave abnormalities, and the computer interprets it as normal.

Which of the following recent tests for CAD is most reassuring that the patient’s current pain is noncardiac?

A. An exercise stress echocardiogram performed 7 months ago with no inducible wall motion abnormalities and interpreted as negative for inducible ischemia

B. A diagnostic cardiac catheterization performed 3 years ago, which showed clean coronary arteries

C. A nuclear stress test performed last year, which showed no evidence of ischemia and was interpreted as normal

D. An exercise stress ECG with no clear evidence of ischemic ST/T wave changes

Answer: B. While recent negative provocative (stress) testing for CAD reduces the likelihood of MI or cardiac death in the year following, this does not exclude the possibility of obstructive CAD. However, a recent negative cardiac catheterization portends an excellent long-term prognosis and very low risk of MI or cardiac death in the coming 5 to 10 years.

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Last Updated on November 16, 2022

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