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Recurrent Low Risk Chest Pain: GRACE Guidelines
When providers are early in their training, this tends to lead to questions of “how long is a negative stress test good for?” “What about a negative cath? - Is that good for 2 years, 4, years, 6?” “What about a negative CCTA?”
In the first (of many to come) GRACE guidelines (Guidelines for Reasonable and Appropriate Care in the Emergency Department), SAEM sought to tackle many of these questions as they looked at Recurrent, Low-risk Chest Pain in the Emergency Department.
A Weakness in the HEART?
In this month’s Journal Club Recap we take a look at some recently published literature about common heart related complaints in the ED. First, we look at the now nearly ubiquitously used HEART pathway. In a US population, do the benefits of decreased health care utilization sustain themselves to a year out of an index visit? Then we turn our attention to atrial fibrillation with RVR. Does the utility infielder of ED medications, Magnesium, actually help with more rapid rate control? And, should the results of a consensus panel sway us to treat A fib with RVR as an outpatient?
STEMI and STEMI Equivalents, i.e. Who Needs the Cath Lab Now!
1. The ACC/AHA Criteria (1) (2)
ST-elevation in 2 contiguous leads that is:
Men < 40: 2.5 mm ST-elevation in V2 or V3, 1 mm in any other lead
Men > 40: 2.0 mm ST-elevation in V2 or V3, 1 mm in any other lead
Women: >1.5 mm ST-elevation in V2 or V3, 1 mm in any other lead
STEMI's have a 90-minute door-to-balloon time mandate from the Center for Medicare Services (CMS). To be good stewards of our resources we need to be familiar the false positive STEMI patterns. Ultimately, however, some degree of over triage and activation for false positives is expected and (potentially even) desirable.