Chest pain physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

Physical examination should focus on evaluating for the life-threatening causes of chest pain first. A complete physical exam should be done, which includes a thorough cardiac, lung, and abdominal exam.

Physical Examination

Vitals

• Temperature (pericarditis, pleuritis, fever can precipitate ischemic attacks)
• Absent or decreased pulses in limbs (aortic dissection all four limbs), tachycardia (pulmonary embolism)
• Blood pressure in both the arms (aortic dissection)

Neck

• Elevated jugular venous pulse

Heart

• Auscultation
  • Third and fourth heart sound
  • Carotid bruit
  • Pericardial rub (pericarditis)
  • Murmur (systolic murmur in hypertrophic cardiomyopathy, aortic stenosis)

Lung

• Palpation - shift in trachea from midline (tension pneumothorax)
• Auscultation - decreased breath sound (pulmonary edema), pleural rub (pleuritis, pneumonia)

Abdomen

• Inspection, palpation and auscultation to evaluate for gastrointestinal etiologies of chest pain
• May show distension, RUQ tenderness.
• Rectal examination - occult bleeding (peptic ulcers)

Neurologic

• Cerebrovascular accidents (aortic dissection)
• Paraplegia

Musculoskeletal/Extremities

• Palpation with pain reproducibility
• Unilateral extremity enlargement, pain, and erythema (deep vein thrombosis)

Skin

• Hyperesthesia and rash (zoster)
• Subcutaneous emphysema (Boerhaave syndrome, pneumothorax).