Rosh Emergency Medicine Practice Test

In a patient presenting with chest pain and risk factors for heart disease, which condition should be primarily considered?

1. Acute coronary syndrome

2. Pericarditis

3. Pulmonary embolism

4. Wolff-Parkinson-White syndrome

The correct answer is: Acute coronary syndrome

The condition that should be primarily considered in a patient presenting with chest pain and risk factors for heart disease is acute coronary syndrome. This encompasses a spectrum of conditions primarily related to myocardial ischemia or infarction due to insufficient blood flow and oxygen to the heart muscle caused by coronary artery disease. Risk factors such as age, hypertension, hyperlipidemia, diabetes, smoking, and family history significantly increase the likelihood of an acute coronary event. Acute coronary syndrome typically presents with chest pain that may feel like pressure or tightness and can radiate to the arms, neck, or jaw. Other symptoms may include shortness of breath, sweating, nausea, or lightheadedness. Rapid identification and management are crucial because the condition can quickly lead to significant morbidity and mortality. In contrast, while conditions like pericarditis, pulmonary embolism, and Wolff-Parkinson-White syndrome can also present with chest pain, they are less commonly associated with acute presentations in patients with recognized heart disease risk factors. For example, pericarditis may come with a sharp, pleuritic pain and is often relieved by sitting forward, while pulmonary embolism may present with sudden onset of pleuritic pain, dyspnea, and signs of hyp