What physical examination should be conducted in patients with NSTE-ACS?
The physical examination in NSTE-ACS can be normal, but signs of HF should expedite the diagnosis and treatment of this condition. Acute myocardial ischemia may cause a S4, a paradoxical splitting of S2, or a new murmur of mitral regurgitation due to papillary muscle dysfunction. However, these signs may also exist without NSTE-ACS and thus are nonspecific. The coupling of pain on palpation suggesting musculoskeletal disease or inflammation with a pulsatile abdominal mass suggesting abdominal aortic aneurysm raises concern for nonischemic causes of NSTE-ACS. The physical examination can indicate alternative diagnoses in patients with chest pain, several of which are life threatening.