Last reviewed: November 2017
Last updated: November  2017

Important updates

Most adults presenting in primary care with chest pain not given a firm diagnosis on first assessment

  • A cohort study of adults with a first episode of chest pain (no previous record of cardiovascular disease) presenting to 223 general practices in the UK found:

  • Most patients had no diagnosis attributed at presentation (72.4%)

  • Most patients still had no diagnosis attributed within the next 6 months

  • Those patients who had no diagnosis attributed to their chest pain at 6 months had a higher long-term incidence of cardiovascular events compared with patients who had been diagnosed with noncoronary pain.

Original source of update

Summary

Differentials

Common

  • Acute coronary syndrome
  • Stable angina
  • Pneumonia
  • Viral pleuritis
  • GERD
  • Costochondritis
  • Anxiety or panic disorder

Uncommon

  • Pulmonary embolism
  • Pericarditis
  • Cardiac tamponade
  • Aortic dissection
  • Aortic stenosis
  • Mitral valve prolapse
  • Pneumothorax
  • Pulmonary hypertension
  • Peptic ulcer disease (PUD)
  • Esophageal spasm
  • Acute cholecystitis
  • Pancreatitis
  • Herpes zoster
  • Gastritis

Contributors

Authors VIEW ALL

Professor and Chair

Emergency Medicine

Wright State University Boonshoft School of Medicine

Kettering

OH

Disclosures

JEB declares that he has been engaged as an expert witness in cases involving the evaluation of patients with chest pain.

Dr James E. Brown would like to gratefully acknowledge Dr Marvin H. Eng and Dr Mori J. Krantz, previous contributors to this monograph. MHE declares that he has no competing interests. MJK is a consultant for GlaxoSmithKline.

Peer reviewers VIEW ALL

Cardiologist

St Vincent’s Hospital Melbourne

Associate Professor

Department of Medicine

University of Melbourne

Melbourne

Australia

Disclosures

MJ declares that he has no competing interests.

Gill Foundation Professor of Interventional Cardiology

Director of Cardiac Catheterization Laboratories

Gill Heart Institute

Division of Cardiovascular Medicine

University of Kentucky

Lexington

KY

Disclosures

DM declares that he has no competing interests.

Clinical Lecturer

University of Michigan Congenital Heart Center

Ann Arbor

MI

Disclosures

MB declares that he has no competing interests.

Assistant Professor

Department of Internal Medicine

University of Colorado Health Sciences Center

Denver

CO

Disclosures

EC declares that he has no competing interests.

Research Fellow

Internal Medicine

Albert Einstein College of Medicine/Jacobi Medical Center

Bronx

NY

Disclosures

DS declares that he has no competing interests.

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