University of Maryland School of Medicine

Department of Emergency Medicine

University of Maryland School of Medicine Department of Emergency Medicine

UMEM Educational Pearls

Category: Cardiology

Title: Acute Coronary Syndrome (our number one area of liability) [Part 2]

Keywords: ACS, Legal, documentation (PubMed Search)

Posted: 9/1/2007 by Michael Bond, MD (Updated: 4/17/2014)
Click here to contact Michael Bond, MD

Acute Coronary Syndrome (our number one area of liability) [Part 2]
  • Describing the character of the pain is the most common element of the history (Braunwald and Lee & Goldman).
  • The history is the threshold issue and determines whether the patient enters risk stratification (Braunwald).
  • The most atypical features of chest pain are sharp, pleuritic and positional pain.
  • One-third of all patients with an MI have no chest pain.
  • One set of cardiac enzymes violates a strong national standard of practice.
  • Serial enzymes do not rule out unstable angina.
  • If discharging a patient, document why you felt the patient did not have ACS.
  • The plaintiff attorney literature advises litigators to focus on the history.
Thanks again to Larry Weiss, MD, JD Disclaimer: This information does not constitute legal advice, is general in nature, and because individual circumstances differ it should not be interpreted as legal advice. The speaker provides this information only for Continuing Medical Education purposes.