“Triple-Rule-Out” in Investigating Cases of Acute Chest Pain (Saudi Experience)

Chest pain is one of the most common symptoms in patients presented to Emergency Department (ED). Various differential diagnoses have to be considered, some of them are potentially lifethreatening. Some of these patients were having high risk factors of coronary artery diseases, and are presented with typical chest pain, along with Electrocardiogram (ECG) changes suggestive Acute Coronary Syndrome (ACS). However, many others are present with a typical chest pain with some ECG changes which cannot confirm or exclude myocardial ischemia. Some other diseases can present with clinical picture which can mimic Ischemic Heart Disease (IHD) such as Pulmonary Embolism (PE) aortic dissection [1-3] as well as Pulmonary, Pleural or osseous lesions, that must be taken into account [4]. The diagnosis of the cause of chest pain is a true challenge for ED physicians. The uncertainty of the diagnosis of these cases results in the practice of defensive medicine and consequent un-necessary admissions which costs too much [5-8].