Chest Pain

Approach to  chest Pain

Introduction (Accurate Diagnosis  Remains A  Challenge)

• 5 Million (9%) ED visits
• Second most common cause of ED presentation among adults in the US
• Chest pain is the chief compliant for 1-2% of OPC and 70% of ED visits.
• Cardiac etiology found in < 1/3
• 2% of patients with acute MI are unrecognized and discharged from ED.

Common Causes of chest pain

• Cardiac causes
• Pulmonary Embolism
• Thoracic Outlet Syndrome - Prolapsed Disc
• Psychological Pain
• Pulmonary Causes; Pneumonia, Spontaneous Pneumothorax
• Gallbladder disease, Pancreatitis, Transverse Colitis
• Peptic Ulcer, Esophageal Reflux, Spasm
• Costochondritis ,Cervical disk disease ,  Trauma or strain,
• Herpes Zoster

HISTORY IS THE  KEY TO THE  DIAGNOSIS OF  ETIOLOGY OF  CHEST PAIN

CLINICAL APPROACH TO  CHEST PAIN HISTORY

• Site “Where is the pain?”
• Onset “How did it come on?”
• Character “Can you describe the pain?”
• Radiation “Does it radiate anywhere?”
• Associated Features “does it come on with other symptoms?”
• Time course “How long does it last?”
• Relieving Factors “Does anything make it better or worse?”
• Severity “On a scale of 1-10, how bad is the pain?”

LIFE THREATENING  CAUSES

• Oesophageal Rupture
• Acute coronary syndrome
• Dissecting Aortic Aneurysm.
• Cardiac tamponade
• Pulmonary embolism
• Tension Pneumothorax

Risk Factors?????

NOT IMMEDIATELY LIFE-  THREATENING CAUSES

1. Mitral Valve Prolapse
2. Pneumonia
3. Costochondritis
4. Esophagitis
5. Herpes Zoster
6. Gallbladder Disease

Chest Pain Case Scenarios

Approach to chest pain