Patients presenting with acute chest pain are a challenge for attending physicians in private practice and specialists for emergency and acute medicine in hospitals because a wide spectrum of diagnoses may be the cause, ranging from acute myocardial infarction (AMI) to harmless muscular tension. The evaluation of patients with acute chest pain follows basic principles independent of the setting: A thorough clinical investigation by the responsible physician including medical history and physical examination, followed by a 12-channel electrocardiogram (ECG) and further focused diagnostics. The decision about hospital admission, monitoring and further diagnostic steps depends on the estimation of vital risk, the tentative diagnosis and the available diagnostic tools. Besides the ECG, laboratory tests (cardiac troponin, copeptin) and cardiac imaging (primarily the echocardiography) play a key role. Patients who did not necessarily require hospital admission (e. g. after exclusion of AMI) should be offered an inpatient or outpatient concept which enables the timely diagnosis and potential treatment of all relevant diseases in question. The diagnostic strategies need to take into account the pretest probability and for patients with confirmed diagnosis of an acute coronary syndrome (ACS), continuous monitoring and transfer to an emergency department with integrated chest pain unit (CPU) is strongly recommended. In this context, close collaboration between the emergency department and the physicians in private practice should be established.
Keywords: Copeptin; Emergency department; Myocardial infarction; Private practice; Troponin, cardiac.