Millman considers a one day admission appropriate for acute coronary syndrome. This is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischemia. Patients with unstable angina, ECG changes, or both should be admitted to a telemetry bed. A certain subset of patients with stable angina may be treated as outpatients with antianginal agents, but close follow-up is necessary. Patients with chronic stable angina may be considered for discharge from the ER after occurrence of the following:
◦Symptom duration is brief and identical to symptoms experienced in the past.
◦ECG is normal or unchanged.
◦Patient has access to timely follow-up with a primary care provider.
•When in doubt, admit. The usual reason for a patient with chronic stable angina to present to the ED is a change in pattern or severity of symptoms, which makes their angina unstable.
The necessasry length of stay is determined by response to therapy. In many cases, next day discharge is possible; in others, thrombolysis or percutaneous intervention may be considered.
Millman, Chest Pain, Angina/Acute Coronary Syndrome
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