Research Assessment 3

Date: ​September 20, 2019

Subject: ​Emergency Management of Cardiac Chest Pain: A Review

Source:

Herren KR, Mackway-Jones KEmergency management of cardiac chest pain: a

review​Emergency Medicine Journal ​2001;​18:​6-10.

Assessment:

In the United States, one in four deaths are due to heart disease, and nearly half of all

sudden cardiac deaths happen outside a hospital. This means that many people do not pay

attention to the common warning signs of a heart attack. There is an overarching problem in the

United States that affects every individual, but it can be curbed by making the response system

that emergency departments have more efficient. By reading the article, “Emergency

Management of Cardiac Chest Pain: A Review,” I learned what processes are done in the

emergency room of a hospital when a patient complains of chest pain, whether these processes

are efficient or not, and the better alternatives to some traditional methods.

To begin, this study analyzed what happens in an emergency department of a hospital

after a patient enters with complaints of chest pain. The article went into depth about the protocol

that the hospital staff should take in order to rule out myocardial infarction, or commonly known

as a heart attack. I learned that many methods in the status quo are either too expensive or do not

fit in the twelve-hour time frame that is optimal for the survival of the patient. Currently, there is

no perfect test, but there is a combination of procedures that test the enzymes in a patient’s body,

which can be used as a way to see if they are having a heart attack. Why can there not be a way
to seamlessly combine multiple tests in order to facilitate emergency department physicians in

their diagnosis of patients who may be having a heart attack? This is an important factor due to

the fact that many patients who do not have the obvious signs of a heart attack are established to

be low-risk patients, and are discharged quickly. However, this leads to a proportion of patients

who are susceptible to having a heart attack being put in danger. This has lead to the

development of chest pain assessment units, (CPAUs) which determine what risk level a patient

is in. Nevertheless, I believe there should be a way to merge tests that indicate specific markers

that are tell-tale signs of having a heart attack.

The topic of this study is important to me because it shows that a significant amount of

deaths from a heart attack could be preventable by implementing the proper procedures and tests.

This issue is personal to me because my grandfather passed away from a heart attack, and

unfortunately my family was not able to identify the proper signs. The article assesses how

emergency departments today conduct possible heart attack patients and analyzes if what they do

is effective. The study concludes that all patients who may have a risk need to have top priority

in a hospital. Through my ISM journey, I would like to possibly create a system where chest pain

patients are ensured priority, and physicians can have a system that determines if the patient is at

low, moderate, or high risk for cardiac arrest, which can lead to countless lives being saved. I

believe this will decrease the number of patients who are wrongly discharged, and will provide a

way for doctors to efficiently and quickly diagnose and treat a patient. This has significant

ramifications for my topic, cardiology, because a new system can decrease deaths and ensure that

fewer errors occur.

 I was surprised to see that new tests, which include troponin testing, exercise testing, and

echocardiography were deemed invalid for patients in emergency departments. Why do patients

in the emergency department not have the same spectrum of diseases that these tests account for?

Furthermore, I was discouraged by the fact that there is no single test to rule out the chance of a

heart attack in patients with fewer than twelve hours of chest pain. I think that having to wait

twelve hours to get an accurate diagnosis is too long of a time, and physicians should have the

ease of diagnosing patients after a single test when this problem is so prevalent. This exemplifies

how there is still room for improvement in the medical field, and how there can always be new

technology that helps patients more effectively.

As I continue having more interviews with professionals and searching for mentors, I will

keep in mind the way emergency hospitals, and physicians in general, keep track of cardiac chest

pains. Hopefully, if I get the opportunity to shadow a physician in a hospital, I will be able to get

a first-hand account of what systems they have in place to diagnose a patient. I believe that a

crucial piece of the healthcare system lies in the way that it diagnoses patients, and I would like

to possibly devise an organizational system that makes it more convenient and facilitates doctors.
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