Chest Pain

Basics

Description

  • Discomfort in the chest caused by various etiologies, including cardiac, pulmonary, gastrointestinal, and musculoskeletal systems
  • Chest pain is a common ED complaint, representing 5% of visits
  • Second most common ED complaint:
    • 6% of these presentations are life-threatening
    • Risk of life-threatening causes increases with advancing age
  • Annual ED cost for chest pain exceeds $10 billion
  • 40% of patients with chest pain revisit ED within a year
  • Often the presenting symptom of a high-risk etiology:
    • Acute coronary syndrome
    • Pulmonary embolism
    • Aortic dissection
  • Assume life-threatening until proven otherwise
  • Categorization may suggest the underlying etiology, but the presentation of chest pain can be extremely variable and vague

Etiology

  • Thoracic pain:
    • May involve the myocardium, pericardium, aorta, pulmonary artery, mediastinum, and esophagus
    • Pain is deep, visceral, and poorly localized
    • Characteristics vary from severe and crushing to mild, burning, or indigestion
  • Epigastric pain:
    • May involve the descending aorta, diaphragmatic muscles, gallbladder, pancreas, duodenum, and stomach
    • Pain is generally referred to the xiphoid region and the back
  • Pleuritic pain:
    • Inflammation or trauma to the ribs, cartilage, muscles, nerves, pleural or pericardial surface
    • Pain increased by breathing, laughing, coughing, sneezing
    • Tenderness to palpation may be present
  • Chest wall pain:
    • Arises from inflammation of skin and subcutaneous structures
    • Reproduced by palpation, arm movements, neck extension, and vertical pressure on the head

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