R.E.B.E.L. EM - 01 NOV 2013
"SUMMARY
Clinical factors that INCREASE likelihood of ACS/AMI:
- CP radiating bilaterally > right > left
- Diaphoresis associated with CP
- N/V associated with CP
- Pain with exertion
Clinical factors that DECREASE likelihood of ACS/AMI:
Chest pain that is:
- Pleuritic
- Positional
- Sharp, stabbing
- Reproducible with palpation
These were all fantastic articles looking at aspects of the history in helping aide us in clinical decision making, but none of these historical elements alone or in combination can reliably help us rule in or rule out ACS or AMI. Just remember that there are some historical elements (with negative and positive likelihood ratios) that we need to ask our patients to assist in risk stratification in conjunction with an EKG and cardiac biomarkers."
http://rebelem.com/chest-pain-value-good-history/