In Chest Pain & Medical Malpractice, medical malpractice expert witness Barry Gustin, M.D. writes:
On the other hand, older patients whose chest pain increases with palpation of the chest wall may not only have benign chest wall pain particularly if their history, physical exam or ancillary studies suggest a cardiac or pulmonary problem. The same holds true for patients who have a history of stomach ulcers or esophageal reflux and who gain some relief with anti-ulcer/reflux medications. The physician should be careful no to overlook symptoms, signs or other clues which may point to an underlying co-existing cardiac or pulmonary life-threatening illness.
Physicians should not rely too heavily on the electrocardiograms or cardiac enzymes in the ER. The medical literature is replete with studies demonstrating prior acute AMIs in patients with normal electrocardiograms. This phenomena occurs in from 5% to 20% of patients depending upon the study. Cardiac enzymes may be normal in the emergency room too but become elevated hours later because elevated levels are not detected until 4 to 8 hours after the heart muscle is damaged. Therefore, a normal or non-diagnostic ECG and normal cardiac enzymes can not rule out acute cardiac disease or negate the decision to admit a patient with a possible AMI.