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.


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





For risk stratification see ACS - Risk Stratification


  • Treat cause

See Also



  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.