Pulmonary Trunk Left Main Coronary Artery First Septal Perforator Right Coronary Arte RCA) ~ : «__ Left Circumflex Artery (LCX) First Right Ventricular Diagonal Marginal branch Left Anterior Rescencing Posterior Artery (LAD) Descending Artery (PDA) Posterolateral Branch of LCXMultiples of the URL 100 +— Cardiac troponin Days after onset of AMI Upper reference limitAlgorithm for the Evaluation and Management of Patients Having an Chest Pain I Evaluate for Angina’ i q 4 Chest pain suggestive of ACS Non cardiac chest pain Chronic Stable Angina Treatmentas indicated Protocclfor No ST Elevation ST Elevation by alternative clagnosis Chronic Stable Angina jl | ¥ + Evaluate for Non dlagnosic ECS ‘STT changes reperiusion therapy Normal ital biomerkers On going pain ve Biomarkers Hemodynamic instability (Observe: Follow-up at 4-8 hours; + ECG, card.ac biomarkers Aan to hospital SSApa SIEM I Ant-ischemia therapy { 1 t No recurent pain, Recurrent ischemic pain, Negative follow-up studies Dizonosis of ACS canfirmed + Stress study for pravocsble ischemia Considr evaluation of LY function if ischemia present (Test may be performed either prior to discharge or as outpatient) + + Negative Pbtential diagnosis, Positive Non-carciac chest pain Diagnosis of ACS confirmed