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4.1.6. Evaluation of Acute Chest Pain in Patients With
Cocaine and Methamphetamine Use
COR LOE
Recommendation
2a B-NR 1. In patients presenting with acute chest pain, it is reasonable to
consider cocaine and methamphetamine use as a cause of their
symptoms.
4.1.7. Shared Decision-Making in Patients With Acute Chest
Pain
COR LOE
Recommendations
1 B-R 1. For patients with acute chest pain and suspected ACS who are
deemed low risk by a CDP, patient decision aids are beneficial
to improve understanding and effectively facilitate risk
communication.
1 B-R 2. For patients with acute chest pain and suspected ACS who are
deemed intermediate risk by a CDP, shared decision-making
between the clinician and patient regarding the need for
admission, for observation, discharge, or further evaluation in
an outpatient setting is recommended for improving patient
understanding and reducing low-value testing.
4.2. Evaluation of Acute Chest Pain With Nonischemic
Cardiac Pathologies
COR LOE
Recommendation
1 C-EO 1. In patients with acute chest pain in whom other potentially
life-threatening nonischemic cardiac conditions are suspected
(e.g., aortic patholog y, pericardial effusion, endocarditis),
TTE is recommended for diagnosis.
4.2.1. Acute Chest Pain With Suspected Acute Aortic
Syndrome
COR LOE
Recommendations
1 C-EO 1. In patients with acute chest pain where there is clinical
concern for aortic dissection, computed tomography
angiography (CTA) of the chest, abdomen, and pelvis is
recommended for diagnosis and treatment planning.
1 C-EO 2. In patients with acute chest pain where there is clinical
concern for aortic dissection, TEE or CMR should be
performed to make the diagnosis if CT is contraindicated or
unavailable.
