Cardiovascular Medicine Book




Vancouver Chest Pain Rule

Aka: Vancouver Chest Pain Rule
  1. See Also
    1. Chest Pain
    2. Acute Chest Pain Approach
    3. Angina Diagnosis
    4. Cardiac Risk Assessment
    5. Cardiac Risk Management
    6. TIMI Risk Score
    7. Bosner Chest Pain Decision Rule
    8. Cardiac Risk in Diabetes Score
    9. Chest Wall Pain Prediction Rule
    10. Diamond and Forrester Chest Pain Prediction Rule
    11. Framingham Score
    12. HEART Score
    13. GRACE Score
  2. Indications
    1. Low Risk Chest Pain evaluation
  3. Criteria
    1. Completely Normal EKG
      1. No T Wave Inversion
      2. No Left Ventricular Hypertrophy
    2. Troponin negative at 2 hours after emergency department arrival
    3. No Acute Coronary Syndrome history
    4. No Nitrate use
    5. Chest Pain with reassuring history and exam
      1. Reproducible Chest Pain on palpation OR
      2. Non-reproducible Chest Pain, but a patient under age 50 years with a non-concerning history
  4. Interpretation
    1. All criteria present
      1. Low risk for acute coronary events
      2. Consider early disposition home from emergency department with close interval follow-up
    2. Any failing criteria
      1. Cannot exclude ACS
      2. Employ other tools to evaluate further for ACS
  5. Efficacy
    1. Test Sensitivity: 99.1%
    2. Test Specificity: 16%
  6. References
    1. Cullen (2014) Am J Emerg Med 32(2): 129-34 [PubMed]

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