"Low Risk Chest Pain" - Dr. Chang

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

• <40 and negative cocaine
• no history of CAD, no classic cardiac risk factors
• NORMAL ECG (That means completely Normal!!)
  
• Normal biomarker

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

1. Radiation of pain to BUE or RUE
2. Diaphoresis
3. Nausea/Vomiting
4. Exertional

NO Studies risk-stratify patients to NO risk.

Characteristics of pts D/C'd with missed MI

1. Young
2. Atypical

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