Chest pain resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Rim Halaby, Mahmoud Sakr, M.D. [2]

Definition

Chest pain is discomfort or pain that is felt anywhere along the front of the body between the neck and the upper abdomen.

Causes

Life-Threatening Causes

Life-threatening causes are conditions which result in immediate death or disability if left untreated.

• Aortic dissection
• Myocardial infarction
• Pericardial tamponade
• Pneumothorax
• Pulmonary embolism
• Unstable angina

Common Causes

• Biliary colic
• Costochondritis
• Cocaine induced coronary vasospasm
• Esophageal spasm
• GERD
• Myocardial infarction
• Panic attacks
• Pneumonia
• Stable angina

Management

Please find below an algorithm that summarizes the approach to chest pain.

Check vital signs Stabilize the patient Order an EKG Concise history and physical exam

Assess EKG

EKG consistent with ACS

EKG not consistent with ACS

Order a CXR

STEMI Revascularization

NSTEMI Risk stratification

Pneumothorax

Aortic dissection

No significant findings on CXR

Control BP Obtain a CT scan Emergent surgery consult

Assess the pretest probability for pulmonary embolism

References

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