1. CHESTPAIN
With typical or atypical anginal
pattern, pain radiation or
diaphoresis, or cardiac risk factors?
YES
Normal ECG
NORMAL troponin
CONSIDERED NON EMERGENT
PROBLEM(outpatient)
ABNORMAL TROPONIN LEVELS
(check within 6-72 hours after
onset of chest pain)
CARDIAC PATIENT (emergency)
NEEDS MORE ASSESSMENT
abnormal ECG
CARDIAC PATIENT (emergency)
Needs more assessment
NO
WITH Suspicion for pulmonary
embolism
WELLS SCORE LESS THAN 2
ABNORMAL D DIMER WITH CT
SCAN POSTIVE
PULMONARY EMBOLISM
WELLS SCORE GREATER THAN 2
CT SCAN POSTIVE PULMONARY EMBOLISM
VENOUS ULTRASOUND RESULT
POSITIVE
DEEP VENOUS THROMBOSIS
NORMAL CT SCAN AND VENOUS
ULTRASOUND with ABNORMAL D
DIMER
WELLS SCORE (GREATER THAN 6)
PERFORM PULMONARY
ANGIOGRAPHY FOR FURTHER
TEST
WITH NO Suspicion for pulmonary
em
bolism
WITH -
FEVER EGOPHONY AND DULLNESS
IN PERCUSSION
PNEUMONIA
WITH NO -
FEVER EGOPHONY AND DULLNESS
IN PERCUSSION
WITH SPONTANEOUS FRIGHT
ANXIETY, PALPITATIONS, DYSPNEA
OR FAINTNESS IN THE PAST 6 MOS
PANIC DISORDER
PAIN WITH PALPITATION CHEST WALL PAIN
PAIN WITH NO PALPITATION
HEART FAILURE
GASTROINTESTINAL PATHOLOGY
LEGEND:
GENERAL-BLACK , LIGHT BLUE AND ORANGE
CARDIO RELATED- BROWN
PULMO RELATED- BLUE
GASTRO AND OTHERS- VIOLET

2. CONTINUATION:
Character Duration Location
Angina pectoris
(myocardial ischemia)
Chest heaviness, tightening, constricting,
choking, burning
Stable angina pectoris: short duration<5 min
Unstable angina pectoris:
 often prolonged 5-10min
 sometimes lasting hours with changing
intensity
Center of chest, over sternum or just to the
left of it, sometimes ringlike;
radiation to shoulder/arms (left >right, usually ulnar side),neck/jaw, epigastrium
(seldom back)
Myocardial infarction Excruciating, severe constriction
and tightening, dyspnea
Building up over minutes;
most often persistent (>30 min)
Precordial, radiating as in angina pain
Pericarditis Sharp, severe, stabbing, tearing, varying with respiration, position, and motion
(increasing pain in recumbency
and with deep inspiration or coughing)
Persistent Often precordial; not infrequently
radiating to
neck and shoulders
Aortic stenosis Exercise-induced chest heaviness or tightening, often accompanied by dyspnea Similar to angina pectoris
Arrhythmias Sharp pain at rest Ending with stop of arrhythmia Precordial, radiating to throat
Mitral valve prolapse Sharp Often of longer duration Left side of chest
Cardio Chest heaviness, tightening, constricting,
choking, burning
Center of chest, over sternum or just to the
left of it, sometimes ringlike; radiation to
shoulder/arms (left >right, usually ulnar
side),neck/jaw, epigastrium (seldom back)
Stable angina pectoris: short duration<5
min
Unstable angina pectoris:
often prolonged 5-10min sometimes
lasting hours with changing intensity
Excruciating, severe constriction and
tightening, dyspnea
Precordial, radiating as in angina pain
Myocardial infarction
Building up over minutes;
most often persistent (>30 min)
Sharp, severe, stabbing, tearing, varying
with respiration
Often precordial; not infrequently radiating
to neck and shoulders
Pericarditis
persistent pain
Sharp pain
at rest Precordial, radiating to throat
CHECK ECG FOR ARRYTHMIAS
PAIN Ending with stop of arrhythmia
not at rest
MITRAL VALVE PROLAPSE
PAIN AT LEFT SIDE OF CHEST