Cardiovascular Disease Overview

Every year more than 5 million Americans are evaluated in hospital emergency departments (ED) because of chest pain, making it one of the most common reasons for ED visits.^1-3 Heart disease is one of the most dangerous causes of chest pain; however, chest pain can also be caused by a pulmonary embolism, gall bladder disease or even indigestion.⁴ This represents a significant dilemma for ED physicians because they must quickly determine which chest pain symptoms are cardiac in origin and which are not. If the chest pain is a cardiac problem, it must be quickly determined exactly what is going on with the patient's heart.

Heart disease includes several related conditions, all of which are caused by the inability to provide enough nourishment to the heart muscle:

• Heart attack (also known as Myocardial Infarction)
• Angina pectoris
• Silent ischemia

Of the patients who present to the hospital with chest pain, approximately 75% are found to lack objective evidence of an unstable Acute Coronary Syndrome (ACS).^5,6An Acute Myocardial Infarction (AMI or heart attack) or an unstable angina is confirmed in no more than 30% of patients who are admitted to the hospital with suspected ACS. These potentially unnecessary admissions result in healthcare costs of approximately $6 billion annually in the U.S.⁷

However, between 2% and 8% of patients with an AMI are mistakenly released from the hospital.^8-10 These patients have short-term mortality rates of about 25%, at least twice that expected if they were admitted.¹¹ Because of this, the misdiagnosis of an acute myocardial infarction represents the leading cause of medical malpractice in emergency medicine.¹² Up to 39% of the money awarded against EDs is related to the misdiagnosis and mistreatment of acute coronary syndromes^7,12,13 and the average indemnity for a missed AMI is $280,369.¹³

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