SPECT or SPECT/CT MPI Rest and Stress Although stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has comparable utility to stress echocardiography for the overall detection of ischemia in the emergency room setting [25], there is no relevant literature supporting its use in the setting of acute nonspecific chest pain with low probability of CAD. US Echocardiography Transthoracic Resting Resting transthoracic echocardiography is of utility to document anatomic abnormalities that may be the cause of nonischemic cardiac pains in the acute setting, such as diseases of the myocardium or pericardium or cardiac masses, to improve diagnostic accuracy and efficiency [22]. Resting transthoracic echocardiography has the ability to characterize wall contractile function, and because of its ability to be deployed at the bedside, this consensus report by the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association supports its use to triage patients with acute chest pain [22]. US Echocardiography Transesophageal Transesophageal echocardiography is typically reserved for instances when nonischemic causes of acute chest pain, such as thoracic dissection, are under clinical consideration. It may be used as a follow-up to a nondiagnostic transthoracic study but is sometimes chosen initially when transthoracic echocardiography is anticipated to be nondiagnostic, such as related to patient body habitus or inability to comply with breathing instructions [22]. There is no relevant literature supporting its use in the setting of acute nonspecific chest pain with low probability of CAD. Acute Nonspecific Chest Pain There is no relevant literature to support the use of CTA chest with intravenous (IV) contrast in the evaluation of acute nonspecific chest pain of suspected cardiac etiology as an initial imaging test.
Acute Nonspecific Chest Pain Low Probability of Coronary Artery Disease PCAs. SPECT or SPECT/CT MPI Rest and Stress Although stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has comparable utility to stress echocardiography for the overall detection of ischemia in the emergency room setting [25], there is no relevant literature supporting its use in the setting of acute nonspecific chest pain with low probability of CAD. US Echocardiography Transthoracic Resting Resting transthoracic echocardiography is of utility to document anatomic abnormalities that may be the cause of nonischemic cardiac pains in the acute setting, such as diseases of the myocardium or pericardium or cardiac masses, to improve diagnostic accuracy and efficiency [22]. Resting transthoracic echocardiography has the ability to characterize wall contractile function, and because of its ability to be deployed at the bedside, this consensus report by the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association supports its use to triage patients with acute chest pain [22]. US Echocardiography Transesophageal Transesophageal echocardiography is typically reserved for instances when nonischemic causes of acute chest pain, such as thoracic dissection, are under clinical consideration. It may be used as a follow-up to a nondiagnostic transthoracic study but is sometimes chosen initially when transthoracic echocardiography is anticipated to be nondiagnostic, such as related to patient body habitus or inability to comply with breathing instructions [22]. There is no relevant literature supporting its use in the setting of acute nonspecific chest pain with low probability of CAD. Acute Nonspecific Chest Pain There is no relevant literature to support the use of CTA chest with intravenous (IV) contrast in the evaluation of acute nonspecific chest pain of suspected cardiac etiology as an initial imaging test.