Low Risk Cardiac Chest Pain: A Rational Approach to Chest Pain in the ER

Program description

Chest pain management is one of the most critical challenges in the emergency department (ED). Chest pain accounts for 5 to 20 % of all ED admissions, making it the second most common reason to present to the ED in the United States. Causes of chest pain vary widely, often leading to life-threatening emergencies. Accurate and fast risk stratification is paramount in the acute management of these patients. Several risk stratification tools have been developed and are applicable to all clinical situations presenting in the ED, including the Manchester triage system and the HEART score. However, there is a lack of awareness of these tools and how to utilize them for the best outcomes of ED patients.

This online CME activity is the result of a recording on Thursday, July 26, 2018, at the Cowden Educational Center, HonorHealth John C. Lincoln Medical Center in Phoenix.


  • Jeffery J. Schultz, MD, FACEP, EmCare Emergency Medicine, HonorHealth John C. Lincoln Medical Center, Phoenix

Target audience

This activity is intended for emergency medicine, internal medicine and primary care physicians, pre-hospital services, nurses, nurse practitioners, physician assistants, medical students and residents.

Activity purpose

The purpose of this activity is to promote multidisciplinary and shared decision-making approaches among the healthcare team, with adherence to national, evidence-based diagnostic and treatment guidelines for chest pain.

The overall goals of this CME activity are to help healthcare providers:

  • Understand the utility and pitfalls of validated chest pain risk stratification tools
  • Understand the sensitivity and specificity of provocative tests in the evaluation and management of low risk chest pain patients
  • Understand the risks and benefits of interventional management vs medical management for patients with ACS
  • Understand the utility of shared decision making in patient management

Learning objectives

At the conclusion of this activity, the learner should be able to:

  1. Explain best practices from the literature regarding acute coronary syndrome (ACS) management, cardiac risk stratification and accelerated diagnostic pathway utilization for patients who present to the ED with chest pain.
  2. Identify high-risk vs low-risk patients for ACS using the HEART score and other tools.
  3. Classify patients into appropriate accelerated diagnostic pathways.
  4. Use techniques to enhance shared decision-making capacity.

Accreditation, disclosures and credit

Acknowledgment: This CME event is not supported by any commercial entity or joint partnership.

Disclosure: Dr. Schultz and members of the planning committee have no relevant financial relationships with a commercial interest to disclose.

Accreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Arizona Medical Association (ArMA). HonorHealth is accredited by the Arizona Medical Association (ArMA) to provide continuing medical education for physicians.

Credit Statement: HonorHealth designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Release Date: 1/10/2019
Review Date: 1/10/2020
Expiration Date: 7/26/2021


This activity will take approximately 1 hour to complete. To receive credit, participants are required to complete the pretest, view the online activity and complete the posttest and evaluation. Transcripts are available upon request by contacting the HonorHealth CME Office (cme@honorhealth.com).

System requirements: Internet Explorer 9 or later; Mozilla Firefox 10 or later; Google Chrome 16 or later; or Safari 5.1 or later.

  1. Complete the pre-test
  2. View the recording
  3. Complete the post-test and evaluation form