Acute Chest Pain

You will definitely be able to observe the care of a number of patients with chest pain during your attachment with us. It is a great opportunity to survey the great variety in the aetiology and level of severity of the causes.

	Intended Learning Outcomes
	The aim is to develop a safe approach to the initial assessment and management of patients presenting with acute chest pain At the end of this attachment you should be able to Identify features in the presenting history and examination that may help clarify whether the pain is most consistent with a cardiac or a non-cardiac cause Identify features in the initial clinical assessment that are suggestive of a potentially dangerous cause of chest pain, in particular: acute coronary syndromes pericarditis aortic dissection pulmonary embolus pneumonia spontaneous pneumothorax pancreatitis acute cholecystitis Identify features in the initial clinical assessment that are diagnostic (versus suggestive) of a benign cause of chest pain Suggest relevant special investigations for identification or exclusion of the above conditions Be able to justify why many patients without a clear cause for their chest pain are admitted to hospital despite the initial investigations being normal

	Learning Resources
	BMJ best practice (via University library): search "Assessment of chest pain" Cameron, Peter. Textbook of adult emergency medicine, 3rd ed. Chapter 2.4: Shock Overview. Churchill Livingstone, New York;Edinburgh 2009.

Practice Point

Chest pain is a very common presentation with a large differential diagnosis. Most causes of chest pain are not serious. In the Emergency Department, our priority is to identify serious, life-threatening and/or time-critical causes of chest pain.

Organ System	Critical Diagnoses	Emergent Diagnoses	Non-emergent Diagnoses
Cardiovascular	STEMI/NSTEMI	USA, Angina	Valvular HD
	Aortic dissection	Pericarditis	Cardiomyopathy
		Coronary vasospasm
		Myocarditis
		Mediastinitis
Respiratory	Tension pneumothorax	Pneumothorax	Pneumonia
	Pulmonary embolus		Pleurisy
			Tumour
			Pneumomediastinum
Gastrointestinal	Oesophageal rupture	Oesophageal tear	GORD, PUD
	GI perforation	Cholecystitis	Oesophageal spasm
		Pancreatitis	Gastroenteritis
		Tumour	Gastritis
			Biliary colic
Musculoskeletal			Sprains / strains
			Chest wall contusion
			Costochondritis
			Rib fractures
			Arthritis
			Tumours
Neurological			Herpes zoster
			Nerve root compression
Other			Psychological
			Hyperventilation

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Acute Chest Pain

Intended Learning Outcomes

Learning Resources

Practice Point