Chest Pain

Overview

Chest pain has a broad differential diagnosis involving cardiac, pulmonary, gastrointestinal, musculoskeletal, and psychological causes.

The history is central to determining the likelihood of an acute cardiovascular cause.

History

Clarify location, character, duration, radiation, provoking and relieving factors, exertional relationship, and associated symptoms.

Dyspnea, diaphoresis, nausea, syncope, or exertional pressure-like discomfort increase concern for a cardiac cause.

Red Flags

Sudden severe pain, hemodynamic instability, neurological symptoms, significant breathlessness, or concerning ECG findings require urgent assessment.

Investigation

ECG and cardiac biomarkers are central when acute coronary syndrome is suspected. Additional testing depends on the differential diagnosis.

The investigation should be driven by the suspected cause rather than by chest pain alone.

Clinical Pearls