Chest Pain

 

 

 

Differential Diagnosis

 

Cardiac

Pulmonary

GI

MSK/neuro

Psychological
  • angina
  • acute coronary syndrome
  • dysrhythmia
  • pericarditis
  • myocarditis
  • aortic dissection
  • endocarditis
  • pneumonia
  • pneumothorax
  • pulmonary embolism
  • pulmonary hypertension
  • lung cancer
  • increased work, ie with asthma, can cause chest wall fatigue
  • GERD
  • peptic ulcer disease
  • perforated viscus
  • esophageal spasm
  • cholecystitis
  • hepatitis
  • costochondritis
  • intercostal strain
  • arthritis
  • rib fracture
  • herpes zoster
  • C,3,4,5 from diaphragm - can be referred as shoulder pain
  • viral pleuritis
  • anxiety
  • panic
  • depression

 

Pleuritic pain is sharp and stabbing, increasing with breathing or movement and relieved with breath holding.

Non-pleuritic pain is deep, aching, crushing.

 

Investigations

  • history
  • physical exam
  • lab investigations
  • diagnostic imaging

History

 

Red Flags include:

  • severe pain
  • pain for >20 min
  • new onset pain at rest
  • severe SOB
  • loss of consciousness
  • hypotension
  • tachycardia
  • bradycardia
  • cyanosis

Physical Exam

Lab Investigations

 

Cardiac enzymes, D-dimers, LFTs should be done if concerned.

Diagnostic Imaging

ECG should be carried out for everyone in whom MI is possible

ECG, CXR if indicated

 

Management

Angina/IHD: nitroglycerin, 5 min between sprays; if no effect after three sprays, call 911 or go to ED

GERD: antacids, H2 blockers, PPIs

costochondritis: NSAIDs