II. Criteria: Risk Factors (1 point for each positive risk factor)

  1. EKG with ischemia or new infarction
    1. ST Elevation >1mm or pathologic Q waves in 2 or more contiguous leads
    2. Criteria not met if changes were present on prior EKG
  2. Systolic Blood Pressure <100 mmHg
    1. Hypotensive reading at any point during the emergency department stay
  3. Congestive Heart Failure signs
    1. Rales heard above the bases bilaterally
  4. Chest Pain worse than baseline Angina
    1. Known unstable Ischemic Heart Disease or
    2. New post-infarction Angina or
    3. Angina after a coronary revascularization procedure or
    4. Pain similar to prior Myocardial Infarction

III. Interpretation (with risk of major cardiac event in subsequent 30 days)

  1. Very Low Risk (<1 %)
    1. No risk factors
  2. Low Risk (<5%)
    1. Normal EKG and 1 or less risk factor
  3. Moderate Risk (7%)
    1. Normal EKG and 2 or more risk factors or
    2. Suspected ischemia on EKG and 1 or less risk factors
  4. High Risk (18%)
    1. Suspected MI on EKG or
    2. Suspected ischemia on EKG and 2 or more risk factors

V.

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