Chest pain

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See Acute coronary syndrome (main) for ACS specific workup and risk stratification; see Chest pain (peds) for pediatric patients.

Background

Clinical Features

Risk of ACS

Clinical factors that increase likelihood of ACS/AMI:[1][2]

  • Chest pain radiating both arms >R arm >L arm
  • Chest pain associated with diaphoresis
  • Chest pain associated with nausea/vomiting
  • Chest pain with exertion

Clinical factors that decrease likelihood of ACS/AMI:[3]

  • Pleuritic chest pain
  • Positional chest pain
  • Sharp, stabbing chest pain
  • Chest pain reproducible with palpation

Male and female patients typical present with similar symptoms[4]

Differential Diagnosis

Chest pain

Critical

Emergent

Nonemergent

Evaluation

For risk stratification see ACS - Risk Stratification

Management

  • Based on underlying cause

Disposition

See Also

Video

References

  1. Body R, Carley S, Wibberley C, et al. The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes. Resuscitation. 2010;81(3):281–286. PMID: 20036454
  2. Panju AA, Hemmelgarn BR, Guyatt GH, et al. The rational clinical examination. Is this patient having a myocardial infarction? JAMA. 1998;280(14):1256–1263. PMID: 9786377
  3. Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA. 2005;294(20):2623–2629. PMID: 16304077
  4. Gimenez MR, et al. Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction. JAMA Intern Med. 2014; 174(2):241-249.