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    Chest Pain

    Chest Pain is a topic covered in the 5-Minute Emergency Consult.

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    Emergency Central

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    Basics

    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

    • Thoracic:
      • Acute coronary syndrome
      • Pericarditis
      • Myocarditis
      • Stress-induced cardiomyopathy
      • Cardiac syndrome X
      • 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 sec–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. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307450/all/Chest_Pain. Accessed April 24, 2019.
    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. Available 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 2019 April 24]. 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 ID - 307450 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 -