Clinical cases of electrosonography in patients with acute chest pain

Acute chest pain is one of the most frequent complaints in emergency facilities. The differential diagnosis of chest pain is wide and can vary from a benign complaint to a life-threatening illness. Although it is very common, it poses upon the treating physician a diagnostic challenge as the correlation between the quality and characteristics of the chest pain and a specific diagnosis is low, and the overlap is high. Electrocardiogram (ECG) and trans-thoracic echocardiography (TTE) are two of the most important tests in the early workup stages of the acute chest pain patient and can help diagnose correctly the etiology of the chest pain and rule out alternative diagnoses. The combined use of ECG and TTE in the workup process is termed Electrosonography, and in this chapter we present the use of electrosonography in the evaluation of acute chest pain patients. The chapter first presents an algorithm demonstrating the workflow for evaluating an acute chest pain patient. The algorithm lays out the recommended steps for evaluating the patient including the timing of when ECG and TTE should be done and the next step in the workup. The second part of the chapter includes 16 acute chest pain patients who presented at an emergency facility. Each case includes 4 pages in a learning-friendly format with the information gathering gradually allowing the reader to test his knowledge in ECG and TTE, leading to electrosonography, the combined information obtained from the ECG and TTE. The case number of each scenario is imbedded in the algorithm near the specific diagnosis. The cases in this chapter can be studied independently or as part of the algorithm, as an example for each diagnosis. Learning the algorithm and the different chest pain cases can aid the physician with the challenging yet critical process of evaluating and treating acute chest patients in an emergency setting.