Acute chest pain

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]

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

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

Gender differences in ACS

  • Women with ACS are less likely to be treated with guideline-directed medical therapies, less likely to undergo cardiac catheterization, and less likely to receive timely reperfusion.[4]
  • Men are more likely to report central chest pain, while women are more likely to report fatigue, dyspnea, indigestion, nausea/vomiting, palpitations and weakness[5], although some studies have found fewer differences in presentation[6]
  • Women are more likely to delay presentation. Additional factors associated with delay in seeking treatment include older age, Black or Hispanic race, and lower education and socioeconomic levels.[7]

Differential Diagnosis

Chest pain

Critical

Emergent

Nonemergent

Evaluation

Workup

Younger patients/less concerning story

Older patients/more concerning story

Diagnosis

Consider differential diagnosis (see above) and rule out emergent causes

Management

  • Based on underlying cause

Disposition

  • Based on underlying cause

See Also

Videos

[[Category:WikEM]]

[[Category:WikEM]]

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. Mehta LS, et al. Acute myocardial infarction in women: A scientific statement from the American Heart Association. Circulation. 2016; 133:916-947.
  5. Mehta LS, et al. Acute myocardial infarction in women: A scientific statement from the American Heart Association. Circulation. 2016; 133:916-947.
  6. 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.
  7. Mehta LS, et al. Acute myocardial infarction in women: A scientific statement from the American Heart Association. Circulation. 2016; 133:916-947.

Authors:

Ross Donaldson