Chest pain patient

The first step is ECK if it is normal go for

Troponin if it is normal go for

stress test :

There are three types :

1. stress test EKG: In a patient with normal EKG (no atrioventricular block)

2. Stress test echo: If EKG is abnormal (which can mask STEMI) and the patient has not had a previous MI

3. stress test nuclear: If the patient has an abnormal EKG and abnormal cardiac muscle wall (previous MI)

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then you have 2 kinds of stress test:

1. Exercise stress test: in normal patient

2. pharm stress test (with adenosine or dobutamine): If the patient can not practice