BOccThy MBBBS FACEM, Qld.
MBBS, FACEM, PhD, Senior Staff Specialist in Emergency Medicine, Royal Brisbane and Women@s Hospital, Brisbane, Qld; Adjunct Professor, Queensland University of Technology, Qld; Associate Professor, Faculty of Medicine, University of Queensland, Qld.
Aust J Gen Pract. 2018 May;47(5):246-251. doi: 10.31128/AFP-08-17-4304.
Chest pain is a common presentation and diagnosis can be challenging. There are many causes for chest pain, including life-threatening conditions such as acute coronary syndrome (ACS), which can prove difficult to diagnose.
This article focuses on diagnosis and early management of patients with possible ACS. Key differentials and essential primary care investigations and management are outlined. Hospital-based risk stratification and management are described, providing an outline of what patients can expect if referred to hospital.
In primary care, an electrocardiogram (ECG) is the only investigation required for most patients while referral is made to hospital. Troponin testing should rarely be requested to investigate patients with suspected ACS in the primary care setting. Initial treatment may include aspirin, glyceryl trinitrate and oxygen if required. If ACS is suspected as the cause of the symptoms, urgent referral for definitive risk stratification is required.
胸痛是一种常见的表现，诊断可能具有挑战性。胸痛有很多原因，包括危及生命的疾病，如急性冠状动脉综合征（ACS），这可能难以诊断。
本文重点介绍疑似 ACS 患者的诊断和早期管理。概述了主要的鉴别诊断和基本的初级保健检查和管理。描述了基于医院的风险分层和管理，提供了患者如果转至医院可以预期的情况概述。
在初级保健中，对于大多数患者，唯一需要的检查是心电图（ECG），同时将其转至医院。在初级保健环境中，很少需要肌钙蛋白检测来调查疑似 ACS 的患者。初始治疗可能包括阿司匹林、硝酸甘油和如果需要的氧气。如果怀疑症状是 ACS 引起的，则需要紧急转至医院进行明确的风险分层。
