Always beware of diagnostic momentum!
Young age alone does NOT rule out ACS
Very Low risk patients are defined and may be D/C'd with no further ED evaluation
Non-specific ST changes are NOT negligible in the symptomatic patient.
PITFALL: Placing too much emphasis on "atypical" symptoms for ACS
Things that Increase Likelihood Ratio for ACS/MI
NO Studies risk-stratify patients to NO risk.
Characteristics of pts D/C'd with missed MI
Know your ECGs! You need to strive to be the ECG Master in your hospital!
So invest some time and effort into it... Learn from the best: http://www.mededmasters.com/ecg-lessons-by-amal-mattu.html