Review

. 2023 Sep 7;5(12):891-903.

doi: 10.1016/j.cjco.2023.09.001. eCollection 2023 Dec.

Chest Pain Evaluation: Diagnostic Testing

Benjamin J W Chow^{1

2}, Paul Galiwango³, Anthony Poulin⁴, Paolo Raggi⁵, Gary Small¹, Daniel Juneau⁶, Mustapha Kazmi⁷, Bilal Ayach⁸, Rob S Beanlands¹, Anthony J Sanfilippo⁸, Chi-Ming Chow⁹, D Ian Paterson¹, Michael Chetrit¹⁰, Davinder S Jassal¹¹, Kim Connelly⁹, Eric Larose¹², Helen Bishop¹³, Malek Kass¹⁴, Todd J Anderson⁷, Haissam Haddad¹⁵, John Mancini¹⁶, Katie Doucet¹⁷, Jean-Sebastien Daigle¹⁸, Amir Ahmadi¹⁹, Jonathan Leipsic^{16

20}, Siok Ping Lim²¹, Andrew McRae⁷, Annie Y Chou^{16

22}

Affiliations

¹ Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
² Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Medicine, Scarborough Health Network and Lakeridge Health, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Medicine, Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada.
⁵ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁶ Department of Radiology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
⁷ Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
⁸ Department of Medicine, Lakeridge Health, Queen's University, Kingston, Ontario, Canada.
⁹ Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Department of Cardiovascular Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
¹¹ Department of Physiology and Pathophysiology, Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹² Department of Medicine, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Quebec, Canada.
¹³ Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁴ Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁵ Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁶ Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁷ Peterborough Regional Health Centre, Kawartha Cardiology Clinic, Peterborough, Ontario, Canada.
¹⁸ Department of Internal Medicine, Dr Everett Chalmers Hospital, Fredericton, New Brunswick, Canada.
¹⁹ Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²⁰ Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
²¹ Mayfair Diagnostics, Saskatoon, Saskatchewan, Canada.
²² Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.

PMID: 38204849
PMCID: PMC10774086
DOI: 10.1016/j.cjco.2023.09.001

Review

Chest Pain Evaluation: Diagnostic Testing

Benjamin J W Chow et al. CJC Open. 2023.

. 2023 Sep 7;5(12):891-903.

doi: 10.1016/j.cjco.2023.09.001. eCollection 2023 Dec.

Authors

Affiliations

¹ Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
² Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Medicine, Scarborough Health Network and Lakeridge Health, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Medicine, Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada.
⁵ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁶ Department of Radiology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
⁷ Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
⁸ Department of Medicine, Lakeridge Health, Queen's University, Kingston, Ontario, Canada.
⁹ Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Department of Cardiovascular Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
¹¹ Department of Physiology and Pathophysiology, Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹² Department of Medicine, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Quebec, Canada.
¹³ Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁴ Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁵ Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁶ Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁷ Peterborough Regional Health Centre, Kawartha Cardiology Clinic, Peterborough, Ontario, Canada.
¹⁸ Department of Internal Medicine, Dr Everett Chalmers Hospital, Fredericton, New Brunswick, Canada.
¹⁹ Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²⁰ Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
²¹ Mayfair Diagnostics, Saskatoon, Saskatchewan, Canada.
²² Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.

PMID: 38204849
PMCID: PMC10774086
DOI: 10.1016/j.cjco.2023.09.001

Abstract
in English, French

Chest pain/discomfort (CP) is a common symptom and can be a diagnostic dilemma for many clinicians. The misdiagnosis of an acute or progressive chronic cardiac etiology may carry a significant risk of morbidity and mortality. This review summarizes the different options and modalities for establishing the diagnosis and severity of coronary artery disease. An effective test selection algorithm should be individually tailored to each patient to maximize diagnostic accuracy in a timely fashion, determine short- and long-term prognosis, and permit implementation of evidence-based treatments in a cost-effective manner. Through collaboration, a decision algorithm was developed (www.chowmd.ca/cadtesting) that could be adopted widely into clinical practice.

La douleur ou la gêne thoracique sont des symptômes fréquents qui peuvent poser un dilemme diagnostique pour de nombreux médecins. Les erreurs de diagnostic d’une cause aiguë ou chronique progressive d’origine cardiaque peuvent d'ailleurs entraîner un risque considérable de morbidité et de mortalité. La présente synthèse porte sur les différentes options et modalités d’établissement du diagnostic et de la gravité d’une coronaropathie. Un algorithme efficace pour le choix des tests doit être adapté à chaque patient afin de maximiser l’exactitude diagnostique dans les plus brefs délais, de déterminer le pronostic à court et à long terme, et de permettre une mise en œuvre de traitements fondés sur des données probantes tout en tenant compte des coûts. Un algorithme décisionnel a donc été conjointement mis au point (www.chowmd.ca/cadtesting) et pourrait être largement adopté dans la pratique clinique.

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Chest Pain Evaluation: Diagnostic Testing

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Chest Pain Evaluation: Diagnostic Testing

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