Other cardiovascular entities, such as aortic aneurysms, aortic dissections, and pulmonary embolism, may be suggested from the chest radiograph but with far lower sensitivity than in other imaging modalities, such as multidetector CT. Noncardiac findings associated with chest pain that can be identified on chest radiography include pneumothorax, fractured ribs, pleural effusions, and pneumonia, among others. Chest Pain-Possible Acute Coronary Syndrome Association class I, level A recommendation for evaluation of suspected ACS [34] and has a well-established, well- supported track record in evaluating acute chest pain patients [35,36]. US Echocardiography Transthoracic Stress Stress echocardiography has been shown to be a modality equivalent to stress SPECT MPI in the acute setting in low- to intermediate-risk patients, with either exercise or a stress pharmacologic agent (such as dobutamine) inducing focal wall-motion abnormalities in the region(s) of ischemia [40-42]. When compared with stress ECG, stress echocardiography of acute chest pain patients in the emergency department has been shown to lead to fewer late events, including rehospitalization and late percutaneous coronary intervention [43,44], as well as excellent accuracy in predicting obstructive CAD on coronary angiography or subsequent cardiovascular events [45]. Positive stress echocardiography has been shown to identify incrementally more patients requiring revascularization in patients suspected of ACS when compared with a standard of care without use of imaging [46,47]. US Echocardiography Transthoracic Resting US Echocardiography Transthoracic Resting Conventional resting echocardiography in the emergency department has some limited benefit for detection of ischemic myocardium with abnormal wall motion and thereby risk stratification of suspected ACS patients [48,49]; however, it is more widely used for the evaluation of heart failure, valvular dysfunction, and pericardial effusion [41].
Chest Pain Possible Acute Coronary Syndrome PCAs. Other cardiovascular entities, such as aortic aneurysms, aortic dissections, and pulmonary embolism, may be suggested from the chest radiograph but with far lower sensitivity than in other imaging modalities, such as multidetector CT. Noncardiac findings associated with chest pain that can be identified on chest radiography include pneumothorax, fractured ribs, pleural effusions, and pneumonia, among others. Chest Pain-Possible Acute Coronary Syndrome Association class I, level A recommendation for evaluation of suspected ACS [34] and has a well-established, well- supported track record in evaluating acute chest pain patients [35,36]. US Echocardiography Transthoracic Stress Stress echocardiography has been shown to be a modality equivalent to stress SPECT MPI in the acute setting in low- to intermediate-risk patients, with either exercise or a stress pharmacologic agent (such as dobutamine) inducing focal wall-motion abnormalities in the region(s) of ischemia [40-42]. When compared with stress ECG, stress echocardiography of acute chest pain patients in the emergency department has been shown to lead to fewer late events, including rehospitalization and late percutaneous coronary intervention [43,44], as well as excellent accuracy in predicting obstructive CAD on coronary angiography or subsequent cardiovascular events [45]. Positive stress echocardiography has been shown to identify incrementally more patients requiring revascularization in patients suspected of ACS when compared with a standard of care without use of imaging [46,47]. US Echocardiography Transthoracic Resting US Echocardiography Transthoracic Resting Conventional resting echocardiography in the emergency department has some limited benefit for detection of ischemic myocardium with abnormal wall motion and thereby risk stratification of suspected ACS patients [48,49]; however, it is more widely used for the evaluation of heart failure, valvular dysfunction, and pericardial effusion [41].