Usefulness of Chest Wall Tenderness as Bedside Test to Exclude Acute Coronary Syndrome in Different Demographic Groups
Usefulness of Chest Wall Tenderness as Bedside Test to Exclude Acute Coronary Syndrome in Different Demographic Groups
To determine the significance of a simple bedside clinical test (chest wall tenderness) to
 exclude myocardial ischemia in different demographic groups.
When a patient is presenting with acute chest pain at the ER of the University Hospital of
 Zurich, the study physician in charge, who is acting simultaneously as one of four attending
 clinical physicians, is performing the physical examination according to routine clinical
 practice. The physical examination includes the testing of chest wall tenderness: Palpation
 of chest wall tenderness in lying 30° elevation of chest position. Flat index with
 standardized pressure where spontaneous maximum pain is reported (reproducible vs. not
 reproducible pain vs. no pain). Negative control (right side of chest mid-clavicle
 intercostal 6/7), reproducible vs. not reproducible pain vs. no pain. The same physician, who
 is blinded for the final diagnosis at the time of the physical examination, is also recording
 the patient history including the study interview using the standardized study questionnaire.
Inclusion criteria: All patients over the age of 18 years presenting with the leading
 symptom of first time or recurrent acute chest pain in the emergency room of the Department
 of Internal Medicine, University Hospital of Zurich.

 Exclusion criteria:

 -  Missing informed consent.

 -  Cardiopulmonary unstable patients.

 -  No self reported chest pain.

 -  Recent thoracic surgery within1 year, inflammatory joint disease, fibromyalgia,
 cardiogenic shock.