CONTEMPORARY CARDIOLOGY CHRISTOPHER P. CANNON, MD SERIES EDITOR For other titles published in this series, go to http://www.springer.com/7677 William Franklin Peacock Christopher P. Cannon l Editors Short Stay Management of Chest Pain Editors William Franklin Peacock Department of Emergency Medicine Cleveland Clinic Foundation Mail Code E-19 9500 Euclid Ave Cleveland, OH 44195 USA
[email protected] Christopher P. Cannon Brigham & Women’s Hospital Cardiovascular Division Harvard Medical School 350 Longwood Ave Boston, MA USA
[email protected] ISBN 978-1-60327-947-5 e-ISBN 978-1-60327-948-2 DOI 10.1007/978-1-60327-948-2 Springer Dordrecht Heidelberg London New York Library of Congress Control Number: 2009921897 # Humana Press, a part of Springer ScienceþBusiness Media, LLC 2009 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, c/o Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer ScienceþBusiness Media (www.springer.com) Preface As the aging of America continues, ever increasing numbers of patients present to the hospital with signs and symptoms consistent with an acute coronary syndrome. This has challenged our health-care system, both in terms of sheer numbers and the complexity of their presentations. With increasing age, confounding comorbidities increase in a nearly logarithmic fashion. Noncardiac conditions can obscure the patient’s ability to accurately report their symptoms, or mask a true cardiac presentation. This confluence of events results in the creation of a situation where the task of early emergency department risk stratification and diagnostic evaluation becomes increasingly difficult. In fact, the complaint of ch