5-Minute Emergency Consult
Chest Pain
Chest Pain is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- One of the most frequent chief complaints in the ED
- 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
- Thoracic pain:
- May involve the myocardium, pericardium, the ascending 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 in 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
- Diaphragmatic pleurisy:
- Sharp shooting pains in the epigastrium, lower retrosternal area, or shoulder intensified by thoracic movement
- Chest wall pain:
- Inflammation of skin and SC structures of the chest wall
- Pain is reproduced by:
- Palpation
- Horizontal flexion of the arms
- Extension of the neck
- Vertical pressure on the head
Etiology
Etiology
- Thoracic:
- Acute coronary syndrome
- Pericarditis
- Myocarditis
- Stress-induced cardiomyopathy
- Microvascular ischemia
- Stimulant use
- Thoracic aortic dissection
- Esophagitis
- Esophageal spasm
- GERD
- Esophageal hyperalgesia
- Abnormal motility patterns and achalasia
- Esophageal rupture and mediastinitis
- Epigastric:
- Dissection of the descending aorta
- Peptic ulcer disease
- Pancreatitis
- Cholecystitis
- Splenic rupture
- Hepatic injury
- Subdiaphragmatic abscess
- Pleuritic pain:
- Pulmonary embolism
- Pneumothorax
- Pneumonia
- Costochondritis
- Diaphragmatic pleurisy:
- Splenic rupture
- Hepatic injury
- Subdiaphragmatic abscess
- Esophageal rupture
- Intercostal myositis
- Intercostal neuralgia
- Pectoralis minor strain
- Pericarditis
- Pleuritis
- Pneumonitis
- Rib fractures
- Acute chest syndrome of sickle cell
- Chest wall twinge syndrome:
- Brief episodes of sharp anterior chest pain lasting 30 s–3 min, aggravated by deep breathing and relieved by shallow respirations
- Chest wall pain:
- Chest wall hematoma
- Chest wall laceration
- Herpes zoster
- Thrombophlebitis of the thoracoepigastric vein
- Xiphisternal arthritis
- Adiposis dolorosa
- Breast abscess, fibroadenosis, carcinoma
-- To view the remaining sections of this topic, please sign in or purchase a subscription --
Basics
Description
Description
- One of the most frequent chief complaints in the ED
- 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
- Thoracic pain:
- May involve the myocardium, pericardium, the ascending 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 in 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
- Diaphragmatic pleurisy:
- Sharp shooting pains in the epigastrium, lower retrosternal area, or shoulder intensified by thoracic movement
- Chest wall pain:
- Inflammation of skin and SC structures of the chest wall
- Pain is reproduced by:
- Palpation
- Horizontal flexion of the arms
- Extension of the neck
- Vertical pressure on the head
Etiology
Etiology
- Thoracic:
- Acute coronary syndrome
- Pericarditis
- Myocarditis
- Stress-induced cardiomyopathy
- Microvascular ischemia
- Stimulant use
- Thoracic aortic dissection
- Esophagitis
- Esophageal spasm
- GERD
- Esophageal hyperalgesia
- Abnormal motility patterns and achalasia
- Esophageal rupture and mediastinitis
- Epigastric:
- Dissection of the descending aorta
- Peptic ulcer disease
- Pancreatitis
- Cholecystitis
- Splenic rupture
- Hepatic injury
- Subdiaphragmatic abscess
- Pleuritic pain:
- Pulmonary embolism
- Pneumothorax
- Pneumonia
- Costochondritis
- Diaphragmatic pleurisy:
- Splenic rupture
- Hepatic injury
- Subdiaphragmatic abscess
- Esophageal rupture
- Intercostal myositis
- Intercostal neuralgia
- Pectoralis minor strain
- Pericarditis
- Pleuritis
- Pneumonitis
- Rib fractures
- Acute chest syndrome of sickle cell
- Chest wall twinge syndrome:
- Brief episodes of sharp anterior chest pain lasting 30 s–3 min, aggravated by deep breathing and relieved by shallow respirations
- Chest wall pain:
- Chest wall hematoma
- Chest wall laceration
- Herpes zoster
- Thrombophlebitis of the thoracoepigastric vein
- Xiphisternal arthritis
- Adiposis dolorosa
- Breast abscess, fibroadenosis, carcinoma
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Citation
Rosen, Peter, et al., editors. "Chest Pain." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307450/all/Chest_Pain.
Chest Pain. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307450/all/Chest_Pain. Accessed October 27, 2020.
Chest Pain. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult (5th edition). Lippincott Williams & Wilkins. Retrieved October 27, 2020, from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307450/all/Chest_Pain
Chest Pain [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2020 October 27]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307450/all/Chest_Pain.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Chest Pain
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ED - Rosen,Peter,
ED - Shayne,Philip,
ED - Barkin,Adam Z,
ED - Wolfe,Richard E,
ED - Hayden,Stephen R,
ED - Barkin,Roger M,
ED - Schaider,Jeffrey J,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307450/all/Chest_Pain
PB - Lippincott Williams & Wilkins
ET - 5
DB - Emergency Central
DP - Unbound Medicine
ER -
