Co esponding au ho : Mazi Mohammed Alanazi.
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Diagnosis o acu e myoca dial ischemia in pa ien s p esen ing wi h ches pain in he
eme gency depa men using clinical measu es and ca diac ul asonog aphy: A
sys ema ic e iew
Mazi Mohammed Alanazi 1, *, Dhay Mohammed Abdullah 2 and A wa Ayash Alsubhi 2
1 Saudi and Jo danian Boa d Eme gency Medicine, Head o Eme gency Resea ch Uni , Eme gency Depa men , Fi s Heal h
Clus e , Riyadh, Saudi A abia.
2 Saudi boa d eme gency medicine esiden , A med Fo ces Hospi al - Sou he n Region, Abha, Saudi A abia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2344-2351
Publica ion his o y: Recei ed on 04 Ap il 2025; e ised on 11 May 2025; accep ed on 13 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1885
Abs ac
Backg ound: Ches pain is a common cause o eme gency depa men (ED) isi s and p esen s a diagnos ic challenge
due o i s wide ange o e iologies. T adi ional diagnos ic me hods, such as elec oca diog aphy (ECG) and ca diac
bioma ke s, insu icien in ea ly o a ypical p esen a ions. Poin -o -ca e ul asound (POCUS) and ans ho acic
echoca diog aphy (TTE) eme ged as adjunc s o apid bedside assessmen . Ou s udy aims o e alua e he diagnos ic
accu acy and clinical u ili y o POCUS and TTE in acu e myoca dial ischemia in pa ien s p esen ing wi h ches pain,
dyspnea, o suspec ed acu e co ona y synd omes (ACS) in he ED.
Me hods: A sys ema ic e iew was conduc ed acco ding o PRISMA guidelines. S udies included i assessed adul ED
pa ien s using POCUS o TTE o ches pain o ca diopulmona y symp oms. Da a ex ac ed on s udy design,
demog aphics, inclusion c i e ia, ul asound p o ocol, ope a o ype, a ge condi ions, e e ence s anda ds, and
diagnos ic ou comes. Se en s udies in ol ing 2,727 pa ien s we e included.
Resul s: POCUS and TTE imp o ed diagnos ic accu acy, inc eased physicians’ con idence, and educed ime o
diagnosis. Sensi i i y anged om 60% o 92%, and speci ici y om 26% o 99%. The SEARCH 8Es and A–F mnemonic
p o ocols we e e ec i e in apid ED se ings. POCUS shows be e pe o mance han ches X- ay in iden i ying
pulmona y edema, pleu al e usion, and pe ica dial e usion.
Conclusion: POCUS and TTE a e good diagnos ic ools in he ED se ing o pa ien s wi h suspec ed myoca dial
ischemia. These imaging modali ies can enhance diagnos ic p ecision and expedi e app op ia e managemen when
in eg a ed wi h clinical and labo a o y assessmen s.
Keywo ds: Ches Pain; Acu e Myoca dial Ischemia; Poin -O -Ca e Ul asound; T ans ho acic Echoca diog aphy;
Eme gency Depa men ; Diagnos ic Accu acy; Acu e Co ona y Synd ome
1. In oduc ion
Ches pain is one o he mos common causes o eme gency depa men (ED) isi s, accoun ing o millions o cases
and posing a diagnos ic challenge due o i s b oad di e en ial diagnoses (Za ama e al. 2024). A small p opo ion o
hese pa ien s a e diagnosed wi h acu e myoca dial ischemia, he consequences o a missed diagnosis is ca as ophic,
so ea ly and accu a e de ec ion is essen ial (Sweeney e al. 2020). S anda d e alua ion depends on a combina ion o
clinical his o y, physical examina ion, 12-lead elec oca diog aphy (ECG), and ca diac bioma ke s, high-sensi i i y
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2344-2351
2345
oponins (Sweeney e al. 2020). These con en ional ools lack sensi i i y du ing he ea ly s ages o ischemia o in
pa ien s wi h a ypical p esen a ions (La son e al. 2007). The e is in e es in in oducing ca diac ul asonog aphy, such
as ans ho acic echoca diog aphy (TTE) and poin -o -ca e ul asound (POCUS), in o he diagnos ic wo kup. Ca diac
ul asound gi es immedia e isual assessmen o le en icula unc ion, egional wall mo ion abno mali ies (RWMA),
and o he s uc u al indings ha can suppo o e u e a diagnosis o ischemia, be o e ECG o bioma ke changes occu
(Shi an e al. 2017). RWMA de elop wi hin seconds o co ona y occlusion and se e as an ea ly ma ke o myoca dial
ischemia (Za ama, e al. 2024).
POCUS shows p ac ical bene i s in he ED se ing, whe e ime and accessibili y a e impo an , i educe diagnos ic
unce ain y, imp o e iage, and assis in iden i ying al e na i e causes o ches pain (pe ica dial e usion o ao ic
dissec ion) (Ahn, e al. 2017). In SEARCH 8Es p o ocol, POCUS na owed he di e en ial diagnosis and imp o ed
physicians’ con idence in managing pa ien s wi h ches pain and dyspnea (Ahn, e al. 2017). A–F mnemonic p o ocol,
ha e easibili y when pe o med by non-ca diologis s in acu e ca e se ings (Sobczyk, e al. 2015). Ca diac ul asound
is no cu en ly a s andalone es o diagnose myoca dial ischemia, i s ole as a complemen a y ool in he eme gency
diagnos ic pa hway expand. When in eg a ed wi h clinical measu es and labo a o y da a, ca diac ul asonog aphy
imp o es diagnos ic accu acy, op imize esou ce u iliza ion, and imp o e pa ien ou comes in he ED (Baid, e al. 2022).
Ou s udy aims o e alua e he diagnos ic accu acy and clinical u ili y o POCUS and TTE in pa ien s p esen ing wi h
acu e ches pain, dyspnea, o suspec ed acu e co ona y synd omes (ACS) in ED se ings.
2. Me hod
This s udy was conduc ed acco ding o he P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses
(PRISMA) guidelines. The s udy aims o e alua e he diagnos ic accu acy and clinical u ili y o poin -o -ca e ul asound
(POCUS) and ans ho acic echoca diog aphy in pa ien s p esen ing wi h acu e ches pain, dyspnea, o suspec ed acu e
co ona y synd omes in eme gency depa men (ED) se ings.
2.1. Sea ch S a egy and S udy Selec ion
A li e a u e sea ch was conduc ed ac oss da abases (PubMed, Scopus, and Web o Science). Keywo ds used included:
poin -o -ca e ul asound, ocused echoca diog aphy, ches pain, dyspnea, acu e co ona y synd ome, eme gency
depa men , and diagnos ic accu acy. The sea ch was limi ed o a icles published in English. Re e ences o included
a icles we e sc eened o addi ional s udies.
We include; p ospec i e o obse a ional s udies e alua ing adul pa ien s (>18 yea s) p esen ing wi h ches pain,
dyspnea, o hemodynamic ins abili y; use o POCUS o echoca diog aphy as a diagnos ic ool in he ED; and assessmen
o diagnos ic pe o mance, ag eemen wi h inal diagnoses, o clinical impac . S udies we e excluded i in ol ed
pedia ic popula ions, simula ion-based aining only, o lacked o iginal clinical da a.
A e i le and abs ac sc eening, ull ex s o eligible s udies we e e iewed. A o al o se en s udies me he inclusion
c i e ia (Fig 1). F om each included s udy, he ollowing da a we e ex ac ed: s udy design, sample size, pa ien
demog aphics, inclusion c i e ia, ul asound p o ocol, ul asound ope a o , a ge condi ion, e e ence o gold s anda d
es used, and diagnos ic ou comes. Da a ex ac ion was pe o med independen ly by wo au ho s, and disc epancies
we e esol ed by consensus. Sys ema ic e iew syn hesis app oach was adop ed. Key diagnos ic pe o mance measu es
and clinical implica ions we e summa ized and compa ed ac oss s udies o iden i y indings and a ia ions.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2344-2351
2346
Figu e 1 PRISMA conso cha o selec ion p ocess
3. Resul
A o al o se en s udies we e included in his sys ema ic e iew, wi h a o al sample o 2,727 pa ien s in mul iple
geog aphic egions and clinical se ings. All s udies examined he diagnos ic pe o mance o poin -o -ca e ul asound
(POCUS) o ocused echoca diog aphy in pa ien s p esen ing o he eme gency depa men (ED) wi h acu e
ca diopulmona y symp oms, ches pain, dyspnea, and suspec ed acu e co ona y synd omes (ACS).
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2344-2351
2347
The included s udies include adul pa ien s, wi h mean ages anging om 58 o 68 yea s. Some s udies epo ed male
p edominance (Shi an e al., 2016 epo ed 70% male). Mos s udies we e p ospec i e obse a ional, wi h one (Shi an
e al., 2016) mul icen e p ospec i e coho . The clinical indica ions included undi e en ia ed ches pain, dyspnea,
hypo ension, and suspec ed ACS o hea ailu e (Table 1).
All s udies assessed POCUS o ocused ans ho acic echoca diog aphy. The pe son pe o ming he ul asound di e :
eme gency physicians pe o med he scans in mos s udies (Ahn e al. 2017; Baid e al. 2022; Buhumaid e al. 2019),
ca diologis s o ained sonog aphe s in o he s (Shi an e al. 2017 Lee e al. 2015). In Sobczyk e al., 2015, ocused
echoca diog aphy was pe o med by non-specialis esiden s using a simpli ied A–F mnemonic p o ocol.
Ahn e al. (2017) in oduced he SEARCH 8Es p o ocol o diagnose 13 acu e ca diopulmona y pa hologies which include
pulmona y embolism, pneumo ho ax, pe ica dial e usion, and hea ailu e. Baid e al. (2022) ocused on acu e
dyspnea, whe eas Shi an e al. (2016) and Lee e al. (2015) examined s ain echoca diog aphy o de ec ion o CAD in
pa ien s wi h non-diagnos ic ECGs and no mal ini ial oponins. Koun ana e al. (2013) compa ed echoca diog aphy
wi h ischemia-modi ied albumin (IMA) in de ec ing uns able angina. Buhumaid e al. (2018) examined he inc emen al
alue o POCUS o e ches adiog aphy in diagnosis in pa ien s wi h ches pain and sho ness o b ea h.
Ou indings suppo he u ili y o ul asound in he imp o emen o diagnos ic con idence, and o educe he numbe
o di e en ial diagnoses, and p o ide apid bedside assessmen s. Ahn e al. (2017) epo ed a educ ion in he mean
numbe o di e en ials ( om 2.5 o 1.4 pe pa ien , p < 0.001) and an inc ease in diagnos ic con idence sco es ( om 2.8
o 4.3, p < 0.001). Thei SEARCH 8Es p o ocol show ag eemen wi h inal specialis diagnoses (κ = 0.87), wi h sensi i i y
and speci ici y exceeding 90%. Baid e al. (2022) ound ha POCUS had a s ong ag eemen wi h inal diagnoses (κ =
0.668), mainly o pulmona y edema, pleu al e usion, and pe ica dial e usion. POCUS educe ime o diagnosis (median
16 minu es) compa ed o con en ional wo kup (170 minu es, p < 0.001) (Table 2).
Lee e al. (2015) ound ha egional longi udinal s ain (RLS) was be e han isual assessmen o wall mo ion o de ec
CAD, wi h sensi i i y and speci ici y o 92% and 77%, espec i ely. Shi an e al. (2016), ound a sensi i i y (81%), and
speci ici y (26%), wi h limi ed diagnos ic u ili y o uling ou ACS.
Sobczyk e al. (2015) con i m a mnemonic-based ocused echo pe o med by esiden s. Thei indings showed ha apid
echoca diog aphy iden i ied egional wall mo ion abno mali ies (RWMA) and o he signi ican ca diac pa hology.
Koun ana e al. (2013) ound ha echoca diog aphy be e han IMA es ing in de ec ing uns able angina. Echo showed
a speci ici y o 89.3% and a nega i e p edic i e alue (92.6%), and IMA sensi i i y (40%) and speci ici y (28.6%).
Buhumaid e al. (2018) ound ha POCUS had diagnos ic alue be e han ches adiog aphy o mos ho acic
pa hologies, excep pneumonia. In pa ien s wi h no mal POCUS, subsequen CXR did no p o ide addi ional clinically
use ul in o ma ion.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2344-2351
2348
Table 1 cha ac e is ics o he included s udies
Ci a ion
S udy
Design
Inclusion C i e ia
S udy Aim
Pe son Pe o ming
Ul asound
Gold S anda d Tes
Ahn e al.,
2017
P ospec i e
obse a ion
al
>18 y s, ches
pain/dyspnea/hypo ension/shock
E alua e SEARCH 8Es p o ocol o
diagnos ic u ili y and con idence
Eme gency
physicians
Diagnosis by inpa ien
specialis s
Shi an e
al., 2016
Mul icen e
p ospec i e
>45 y s, ches pain, suspec ed ACS,
no ST changes o ele a ed oponin
E alua e 2D longi udinal s ain
(2DLS) in ches pain iage
Ca diologis s ained
in echo
Final diagnosis based on ull
wo kup (including
angiog aphy)
Baid e al.,
2022
P ospec i e
obse a ion
al
>18 y s, acu e dyspnea
Assess PoCUS accu acy and ime
bene i o acu e dyspnea
Eme gency
physicians ained in
PoCUS
Final composi e diagnosis by 2
EM consul an s
Sobczyk e
al., 2015
P ospec i e
obse a ion
al
Suspec ed ACS, >18 y s
Valida e ocused echo (A-F
mnemonic) by non-specialis s
Residen s (non-
echoca diog aphe s)
Ca diologis e iew and
diagnosis
Buhumaid
e al., 2018
P ospec i e
obse a ion
al
>18 y s, ches pain o SOB, wi h
CXR o de ed
E alua e POCUS in na owing
di e en ials and compa e o CXR
Physician-
sonog aphe s
( ellowship ained)
Final composi e diagnosis
Koun ana
e al., 2013
Diagnos ic
compa ison
<3h ches pain, no mal ECG and
oponins
Compa e IMA and echo o uns able
angina exclusion
Ca diologis s
(implied)
Angiog aphy/ hallium
scan/exe cise ECG
Lee e al.,
2015
P ospec i e
Acu e ches pain, excluded MI,
known CAD, al ula , a hy hmias
E alua e s ain echoca diog aphy in
CAD diagnosis and 1-mon h
ou comes
Single in es iga o
blinded o esul s
Co ona y angiog aphy o
CCTA
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2344-2351
2349
Table 2 main indings o included s udies
Ci a ion
Demog aphics
Ta ge Condi ion
Main Findings
Ou come
Ahn e
al. 2017
308 pa ien s, mean
age 67.7±19.1 y s,
184M/124F
Ca diopulmona y causes
o dyspnea, ches pain,
hypo ension
SEARCH 8Es imp o ed
diagnos ic con idence,
educed di e en ials
High accu acy (Kappa
=0.87), sensi i i y 90.9%,
speci ici y 99%
Shi an
e al.
2017
605 pa ien s, mean
age 58±9 y s, 70%
male
Acu e co ona y
synd ome (ACS)
2DLS had low speci ici y
and was no use ul o ule
ou ACS
Sensi i i y 81%, speci ici y
26%, AUC 0.59
Baid e
al. 2022
237 pa ien s, adul ,
mixed gende
Acu e dyspnea
PoCUS showed good
conco dance wi h inal
diagnosis
Kappa =0.668, median
diagnos ic ime: PoCUS 16
min s inal 170 min
Sobczyk
e al,
2015
1312 pa ien s, adul ,
suspec ed ACS
ACS and o he ca diac
pa hologies
Focused echo wi h A-F
mnemonic e ec i e in non-
specialis hands
Con i med RWMAs in
82.87% wi h ACS, high
usabili y and eliabili y
Buhuma
id e al.
2019
128 pa ien s, mean
age 64±17 y s
Causes o ches pain and
sho ness o b ea h
POCUS educed
di e en ials and ma ched
composi e diagnosis
High speci ici y; added alue
o CXR minimal when POCUS
no mal
Koun an
a e al.
2013
33 pa ien s, mean
age 59.8 ±10.8 y s,
28M
Uns able angina
Echoca diog aphy be e
han IMA o diagnosis
Echo; Sens 60%, Spec 89.3%,
NPV 92.6%; IMA no eliable
Lee e al.
2015
104 pa ien s, ED
ches pain egis y
Co ona y a e y disease
(CAD)
RLS be e han RWMA,
GLS, and p e es p obabili y
RLS; Sens 92%, Spec 77%,
AUC =83%, p edic ed 1-mo
e en s
4. Discussion
This sys ema ic e iew aimed o e alua e he diagnos ic accu acy and clinical u ili y o POCUS and TTE in ED pa ien s
wi h acu e ches pain and dyspnea. The esul s o ou s udy a e gene ally consis en wi h p io esea ch in he ield.
Compa ed o he s udy assessing ca diogoniome y (CGM) as an al e na i e diagnos ic modali y o ECG, ou s udy show
he p ac ical and be e applicabili y o POCUS in acu e co ona y synd ome (ACS) e alua ion. CGM showed highe
sensi i i y and speci ici y han es ing ECG bu emains limi ed in use due o equipmen a ailabili y and in e p e a i e
complexi y (Ghad doos e al. 2015). Ou indings suppo he clinical alue o ul asound, which de ec a b oade ange
o ca diopulmona y condi ions in eal ime wi hou eliance on specialized analysis ools.
False-posi i e ac i a ion o ca he e iza ion labs due o o e eliance on ST-segmen changes was epo ed in a la ge
egional egis y, so adi ional eliance on ECG may lead o unnecessa y in asi e p ocedu es (La son e al. 2007). Ou
s udy suppo s POCUS as a complemen a y modali y capable o imp o ing iage accu acy and educing unnecessa y
ac i a ions by isualizing mechanical complica ions o al e na e causes o symp oms.
The Fou h Uni e sal De ini ion o Myoca dial In a c ion (UDMI) explain he ole o high-sensi i i y ca diac oponins
(hs-cTn) in myoca dial in a c ion (MI) diagnosis, when in eg a ed wi h clinical and ECG indings (Thygesen e al. 2018).
Ou s udy indings align wi h his diagnos ic pa hway bu show ha POCUS p o ide immedia e s uc u al and unc ional
insigh s ha bioma ke s canno deli e , mainly when oponin ele a ion is equi ocal o delayed.
Eu opean Socie y o Ca diology (ESC) guidelines ad ise in eg a ing hs-cTn assays and apid diagnosis algo i hms bu
acknowledge he ole o non-in asi e imaging in equi ocal p esen a ions (Colle e al. 2020). Ou esul s imp o e his
guidance by showing ha POCUS can ac as a on line ool, mainly when labo a o y access is delayed o pa ien
ins abili y limi s wai ing pe iods.
A ocused e iew on hs-cTn ei e a ed i s be e sensi i i y in ea ly MI de ec ion, when se ial es ing is employed (Laza
e al. 2022). Ou s udy show ha s uc u al anomalies which include egional wall mo ion abno mali ies o pe ica dial
e usion, iden i iable h ough POCUS, can di ec immedia e managemen be o e bioma ke esul s a e a ailable. Body
e al. examined his o ical ea u es and physical exam indings in ches pain e alua ion and ound limi ed diagnos ic
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2344-2351
2350
eliabili y in isola ion (Body e al. 2010). Ou s udy ound ha his o y and exam a e ounda ional, bu he addi ion o
POCUS enhances diagnos ic ce ain y and iden i ies condi ions ha a e no be appa en h ough symp oms alone.
A e iew by Dezman e al. con i med he inadequacy o his o y and physical exam o oll ou ACS, s essing he isk o
o e - eliance on subjec i e ea u es (Dezman e al. 2017). Ou da a suppo augmen ing clinical judgmen wi h eal-
ime imaging o mis akes in he diagnosis o ACS.
In a B azilian s udy examined pocke -sized echoca diog aphy, ocused ca diac ul asound al e ed he ini ial diagnosis
in 17% o pa ien s, a esul consis en wi h ou own indings (Mancuso e al. 2014). This suppo he u ili y o bedside
ul asound in dynamic ED en i onmen s whe e apid diagnosis and decision-making a e c i ical.
Ou indings a e in line wi h in e na ional guidelines ha endo se an in eg a ed diagnos ic app oach o ACS and
dyspnea, ha includes bioma ke s, ECG, and, bedside imaging. T oponin and ECG we e indispensable, and POCUS gi e
a dis inc ad an age in isualizing ana omical abno mali ies, assessing ca diac unc ion, and iden i ying al e na i e
diagnoses. POCUS p o ides dynamic, poin -o -ca e da a ha can impac pa ien managemen .
Abb e ia ions
• ACS: acu e co ona y synd ome,
• AMI: acu e myoca dial in a c ion,
• CAD: co ona y a e y disease,
• CCTA: co ona y compu ed omog aphy angiog aphy,
• CK: c ea ine kinase,
• CK-MB: c ea ine kinase–myoca dial band,
• CXR: ches X- ay,
• ECG: elec oca diog am,
• ED: eme gency depa men ,
• EF: ejec ion ac ion,
• GRACE: Global Regis y o Acu e Co ona y E en s,
• hs-cTn: high-sensi i i y ca diac oponin,
• IMA: ischemia-modi ied albumin,
• MI: myoca dial in a c ion,
• NPV: nega i e p edic i e alue,
• POCUS: poin -o -ca e ul asound,
• PPV: posi i e p edic i e alue,
• RLS: egional longi udinal s ain,
• RWMA: egional wall mo ion abno mali y,
• SEARCH 8Es: Sonog aphic E alua ion o Ae iology o Respi a o y di icul y: Ches pain and/o Hypo ension
using 8 Es,
• SOB: sho ness o b ea h,
• STEMI: ST-ele a ion myoca dial in a c ion,
• TIMI: Th ombolysis in Myoca dial In a c ion,
• TTE: ans ho acic echoca diog aphy,
• UDMI: Uni e sal De ini ion o Myoca dial In a c ion.
5. Conclusion
The diagnos ic pe o mance o ul asound is s ong in mos o he s udies. Kappa alues, indica ed good ag eemen .
Sensi i i y anged om 60% o 92%, and speci ici y om 26% o 99%, depending on he a ge condi ion and p o ocol.
Se e al s udies con i med ha POCUS can guide ea ly he apeu ic decisions and educe unnecessa y imaging and
ea men delays.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2344-2351
2351
Re e ences
[1] Ahn JH, Jeon J, Toh HC, Noble VE, Kim JS, Kim YS, Do HH, Ha YR. SEARCH 8Es: A no el poin o ca e ul asound
p o ocol o pa ien s wi h ches pain, dyspnea o symp oma ic hypo ension in he eme gency depa men . PLoS
One. 2017 Ma 29;12(3):e0174581. doi: 10.1371/jou nal.pone.0174581.
[2] Baid H, Vempalli N, Kuma S, A o a P, Walia R, Chauhan U, Shukla K, Ve ma A, Chawang H, Aga wal D. Poin o
ca e ul asound as ini ial diagnos ic ool in acu e dyspnea pa ien s in he eme gency depa men o a e ia y
ca e cen e : diagnos ic accu acy s udy. In J Eme g Med. 2022;15(1):27. doi: 10.1186/s12245-022-00430-8.
[3] Body R, Ca ley S, Wibbe ley C, McDowell G, Fe guson J, Mackway-Jones K. The alue o symp oms and signs in
he eme gen diagnosis o acu e co ona y synd omes. Resusci a ion. 2010 Ma ;81(3):281–286. doi:
10.1016/j. esusci a ion.2009.11.014.
[4] Buhumaid RE, S -Cy Bou que J, Shokoohi H, Ma IWY, Longac e M, Li eplo AS. In eg a ing poin -o -ca e
ul asound in he ED e alua ion o pa ien s p esen ing wi h ches pain and sho ness o b ea h. Am J Eme g Med.
2019 Feb;37(2):298–303. doi: 10.1016/j.ajem.2018.10.059.
[5] Dezman Z, Ma u A, Body R. U ili y o he his o y and physical examina ion in he de ec ion o acu e co ona y
synd omes in eme gency depa men pa ien s. Wes J Eme g Med. 2017 Jul;18(4):752–760. doi:
10.5811/wes jem.2017.3.32666.
[6] Ghad doos B, Haghjoo M, Fi ouzi A. Accu acy o ca diogoniome y compa ed wi h elec oca diog aphy in he
diagnosis o co ona y a e y disease. Res Ca dio asc Med. 2015;4(1):1. doi: 10.5812/ca dio ascmed.25547.
[7] Koun ana E, Tziomalos K, Seme zidis P, Dog amma zi F, Sla akis A, Douma S, Zamboulis C, Gele is P. Compa ison
o he diagnos ic accu acy o ischemia-modi ied albumin and echoca diog aphy in pa ien s wi h acu e ches pain.
Exp Clin Ca diol. 2013;18(2):98–100.
[8] La son DM, Menssen KM, Sha key SW, Du al S, Schwa z RS, Ha is J, Meland JT, Unge BT, Hen y TD. ‘False-
posi i e’ ca diac ca he e iza ion labo a o y ac i a ion among pa ien s wi h suspec ed ST-segmen ele a ion
myoca dial in a c ion. JAMA. 2007 Dec 19;298(23):2754. doi: 10.1001/jama.298.23.2754.
[9] Laza DR, Laza FL, Homo odean C, Cainap C, Focsan M, Cainap S, Olinic DM. High-sensi i i y oponin: a e iew
on cha ac e is ics, assessmen , and clinical implica ions. Dis Ma ke s. 2022;2022:1–13. doi:
10.1155/2022/9713326.
[10] Lee M, Chang SA, Cho EJ, Pa k SJ, Choi JO, Lee SC, Oh JK, Pa k SW. Role o s ain alues using au oma ed unc ion
imaging on ans ho acic echoca diog aphy o he assessmen o acu e ches pain in eme gency depa men . In
J Ca dio asc Imaging. 2015 Ma ;31(3):547–556. doi: 10.1007/s10554-015-0588-z.
[11] Mancuso FJN, Siquei a VN, Moisés VA, Gois AFT, de Paola AAV, Ca alho ACC, Campos O. Focused ca diac
ul asound using a pocke -size de ice in he eme gency oom. A q B as Ca diol. 2014;103(6):530–537. doi:
10.5935/abc.20140158.
[12] Shi an A, Blondheim DS, Shimoni S, Jaba en M, Rosenmann D, Sagie A, Leibowi z D, Lei man M, Feinbe g M, Bee i
R, Adawi S, Sho an A, Goland S, Bloch L, Kobal SL, Liel-Cohen N. Two-dimensional s ain echoca diog aphy o
diagnosing ches pain in he eme gency oom: a mul icen e p ospec i e s udy by he Is aeli Echo Resea ch
G oup. Eu Hea J Ca dio asc Imaging. 2017 Sep;18(9):1016–1024. doi: 10.1093/ehjci/jew168.
[13] Sobczyk D, Nycz K, And uszkiewicz P. Validi y o a 5-minu e ocused echoca diog aphy wi h A-F mnemonic
pe o med by non-echoca diog aphe s in he managemen o pa ien s wi h acu e ches pain. Ca dio asc
Ul asound. 2015;13(1):16. doi: 10.1186/s12947-015-0010-y.
[14] Sweeney M, Bleeze G, S o ey S, Cai ns A, Taylo A, Holmes C, Ha S, Law ance N, Old ield WG, Bake CS. The
impac o an acu e ches pain pa hway on he in es iga ion and managemen o ca diac ches pain. Fu u e Heal hc
J. 2020 Feb;7(1):53–59. doi: 10.7861/ hj.2019-0025.
[15] Thygesen K, Alpe JS, Ja e AS, Chai man BR, Bax JJ, Mo ow DA, Whi e HD. Fou h uni e sal de ini ion o
myoca dial in a c ion (2018). J Am Coll Ca diol. 2018 Oc 30;72(18):2231–2264. doi:
10.1016/j.jacc.2018.08.1038.
[16] Za ama V, A ango-G anados MC, Manzano-Nunez R, Sheppa d JP, Robe s N, Plüddemann A. The diagnos ic
accu acy o ca diac ul asound o acu e myoca dial ischemia in he eme gency depa men : a sys ema ic e iew
and me a-analysis. Scand J T auma Resusc Eme g Med. 2024;32(1):19. doi: 10.1186/s13049-024-01192-3.
