DC Inst – Palpitations

You were seen today in the emergency department for palpitations. Your evaluation, which included a history and physical, an EKG and ***chest x-ray, and blood work, showed no emergency cause for your symptoms.

You need to follow-up with your primary care doctor or cardiologist within 3 to 5 days. If you continue to have palpitations, sometimes the next step is to perform continuous monitoring of your heartbeat while you go back to day. This is called a Holter monitor or a ZIO Patch, and needs to be arranged by your PCP or cardiologist.

Please return to the emergency department for chest pain, shortness of breath, lightheadedness or dizziness, or other symptoms that are concerning to you.

DC Inst – Chest Pain

You were evaluated in the Emergency Department today for chest pain. Your evaluation has shown no signs of medical conditions requiring emergent intervention at this time, however we recommend that you follow up with your primary care physician or your cardiologist as soon as possible for further testing as an outpatient.

Please schedule an appointment for follow up with your primary care physician as soon as possible.

Return to the Emergency Department if you experience worsening or uncontrolled chest pain, shortness of breath, light headedness, feeling faint, nausea, vomiting, or any other concerning symptoms.

Thank you for choosing us for your care.

Chest Pain, Atypical (No Troponin)

This patient presents with atypical chest pain, most likely secondary to ***. Differential diagnosis includes ***. Low suspicion for ACS, acute PE (PERC negative***), pericarditis / myocarditis, thoracic aortic dissection, pneumothorax, pneumonia or other acute infectious process. Presentation not consistent with other acute, emergent causes of chest pain at this time. No indication for cardiac enzyme testing.*** Plan to order CXR to evaluate for acute cardiopulmonary causes.***

Plan: labs***, EKG, CXR***, pain control

Chest Pain – Low Risk (Trop Out)

This patient presents with chest pain, with symptoms suggestive of noncardiac chest pain. History without high risk features (e.g., not substernal, no exertional component, not relieved with rest, *** ).

Minimal CAD risk factors (including age), recent negative stress test (<2 years).*** Exam without evidence of volume overload. EKG without signs of active ischemia. HEART score: ***. Given the timing of pain to ER presentation, plan to send single troponin // delta troponin to evaluate for NSTEMI.*** Presentation not consistent with acute PE (Wells low risk *** // PERC negative***), pneumothorax, thoracic arotic dissection, cardiac effusion or tamponade.

Plan: labs, troponin***, EKG, CXR, ASA***, pain control, serial reassessment

Chest Pain – Admit (High Risk)

This patient presents with chest pain, with a history suggestive of ***. No evidence of volume overload or shock on exam. EKG without signs of active ischemia. EKG without evidence of STEMI. Low suspicion for acute PE (Wells low risk ***), pneumothorax, thoracic aortic dissection, cardiac effusion / tamponade. Overall, ACS is being considered given higher risk features, ***, history & physical. HEART score: ***.

Patient will require admission for inpatient risk stratification and possible provocative testing.

Plan: cardiac monitor, EKG, troponins,CXR, ASA, heparin***, pain control, reassess, Cardiology consult***