Vancouver Chest Pain Rule
Identifies chest pain patients who are low risk and safe for early discharge.
Advice
- Patients with an abnormal EKG, positive troponin at 2 hours, or history of prior ACS or nitrate use do not qualify for early discharge.
- Patients with a normal EKG, negative 2-hour troponin, no prior history of ACS or nitrate use, and reproducible pain to palpation can be discharged from the ED without further provocative testing.
- Patients with a normal EKG, negative 2-hour troponin, no prior history of ACS or nitrate use, with non-reproducible chest pain who are age <50 years and have chest pain that does not radiate to the neck, jaw, or arm, can be discharged from the ED without further provocative testing.
Critical Actions
- Low-risk patients can be considered for discharge from the ED without further provocative testing for ACS.
- Consider other etiologies of chest pain, including aortic, esophageal, pulmonary, cardiac, abdominal, and musculoskeletal sources.
- Patients who are not low risk should be managed as per usual chest pain protocols, including but not limited to consideration of aspirin, nitroglycerin, and serial EKGs and biomarkers.