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2.1.1. Focus on the Uniqueness of Chest Pain in Women
COR LOE
Recommendations
1 B-NR 1. Women who present with chest pain are at risk for
underdiagnosis, and potential cardiac causes should always be
considered.
1 B-NR 2. In women presenting with chest pain, it is recommended to
obtain a history that emphasizes accompanying symptoms
that are more common in women with ACS.
2.1.2. Considerations for Older Patients With Chest Pain
COR LOE
Recommendation
1 C-LD 1. In patients with chest pain who are >75 years of age, ACS
should be considered when accompanying symptoms such as
shortness of breath, syncope, or acute delirium are present, or
when an unexplained fall has occurred.
2.1.3. Considerations for Diverse Patient Populations With
Chest Pain
COR LOE
Recommendations
1 C-LD 1. Cultural competency training is recommended to help achieve
the best outcomes in patients of diverse racial and ethnic
backgrounds who present with chest pain.
1 C-LD 2. Among patients of diverse race and ethnicity presenting
with chest pain in whom English may not be their primary
language, addressing language barriers with the use of formal
translation services is recommended.
2.1.4. Patient-Centric Considerations
COR LOE
Recommendation
1 C-LD 1. In patients with acute chest pain, it is recommended that 9-1-
1 be activated by patients or bystanders to initiate transport to
the closest ED by emergency medical services (EMS).
2.2. Physical Examination
COR LOE
Recommendation
1 C-EO 1. In patients presenting with chest pain, a focused
cardiovascular examination should be performed initially
to aid in the diagnosis of ACS or other potentially serious
causes of chest pain (e.g., aortic dissection, PE, or esophageal
rupture) and to identify complications.
