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.
| 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||