Chest Pain - How Many Diagnostics Do We Need?

Patients with acute chest pain need in spite of exclusion of a lifethreatening situation (ACS, aortic dissection, pulmonary embolism) a rapid and sufficient diagnosis. Medical history and clinical examination are the basis of the diagnosis and enable the discovery of the pretest likelihood of the existence of a CHD. Modern biomarker, such as high-sensitivity cardiac troponin T, enable the early exclusion of ACS, long-lasting moderate increases appear to be a marker of increased risk of secondary cardiovascular events. The use of imaging techniques, such as stress echocardiography, nuclear cardiological methods, cardiac computed tomography and cardiac magnetic resonance imaging should occur indication-compatible and in accordance with patient-specific features, local opportunities but also in cost terms. Ideally, the indication for imaging diagnostics should be made by a cardiologist. An optimized diagnosis of patients with chest pain can be expected from the so-called "Chest-Pain-Units" and "Brustschmerz-Ambulanzen" being currently established. Cooperation between the two areas can be regarded as an optimum variant. Standardized diagnosis and clinical pathways with defined schedules are essential for an optimal patient care in hospitals as well as in the outpatient sector.