Approach to the management of patients at low to intermediate risk of ACS

ACS: acute coronary syndrome; ECG: electrocardiogram.
* The initial evaluation includes a brief history, ECG within 10 minutes of arrival, measurement of troponin and basic metabolic panel, a chest radiograph, and continuous ECG monitoring.
¶ High probability of ischemia includes recurrent or ongoing angina, ischemic ECG changes, unstable vital signs, or heart failure. An elevated troponin (or rise and fall pattern) in a patient with consistent clinical findings is evidence of ACS.
Δ Refer to UpToDate content on HEART Pathway risk score for details.
◊ We generally instruct patients to confer with their primary care physician within 2 to 7 days after discharge.
§ The choice of cardiac imaging study is determined by patient characteristics and test availability.