Chest Pain

GENERAL PRINCIPLES

Common causes of chest pain range from life-threatening causes such as myocardial infarction (MI) and pulmonary embolism (PE) to other causes including esophageal reflux, peptic ulcer disease, pneumonia, costochondritis, shingles, trauma, and anxiety.

DIAGNOSIS

History and Physical Examination

• History should include previous cardiac or vascular disease history, cardiac risk factors, and risk factors for VTE.

• Physical examination is ideally conducted during an episode of pain and includes vital signs (bilateral blood pressure [BP] measurements if considering aortic dissection), cardiopulmonary and abdominal examination, and inspection and palpation of the chest.

Diagnostic Testing

Assessment of oxygenation status, CXR, and ECG is appropriate in most patients. Serial cardiac biomarkers should be obtained if there is suspicion of ischemia. Spiral CT and ventilation/perfusion scans can be used to diagnose PE.

TREATMENT

• If cardiac ischemia is a concern, see Chapter 4, Ischemic Heart Disease, for details.

• Musculoskeletal pain typically responds to acetaminophen or NSAID therapy.

• Prompt treatment is necessary if there is high suspicion for MI or PE.