Chest pain resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, 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 include conditions which may result in death or permanent disability within 24 hours 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.
| Assess EKG | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Presence of ST elevation | Absence of ST elevation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Rule out life threatening conditions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Does the patient have both of the following: ❑ There is ST elevation in a limited number of leads that fits the anatomic distribution of a coronary artery (examples would include but are not limited to leads 2,3,F, or Leads v1-v4) | Does the patient have any of the following: ❑ There is ST elevation in multiple leads that does not follow an anatomic distribution of coronary arteries (ST elevation is diffuse) | ❑ Evidence of LBBB | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| STEMI | Pericarditis | LBBB | Aortic dissection | Pulmonary embolism | Tension pneumothorax | Esophageal rupture | |||||||||||||||||||||||||||||||||||||||||||||||||
Look for supportive signs and symptoms:
| Look for supportive signs and symptoms: | Look for supportive signs and symptoms: | |||||||||||||||||||||||||||||||||||||||||||||||||||||