Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the US per year. It is the presenting complaint in 1% of clinic-based visits. In the UK, 1% to 2% of adults attend primary care each year with a new presentation of chest pain. In Belgium and the Netherlands, chest pain was present in about 1% of patient consultations across 118 primary care centres over a 2-week period.
Chest pain may be caused by either benign or life-threatening aetiologies and is usually divided into cardiac and non-cardiac causes.
Acute coronary syndrome (ACS), encompassing unstable angina, ST-elevation myocardial infarction, and non-ST-elevation myocardial infarction, may not be the most common aetiology in patients presenting with chest pain, but excluding ACS is vital because of the mortality associated with untreated myocardial infarction.
This topic concentrates on the assessment of acute chest pain in the emergency setting.
- Acute coronary syndrome
- Stable angina
- Viral pleuritis
- Anxiety or panic disorder
- Pulmonary embolism
- Cardiac tamponade
- Aortic dissection
- Aortic stenosis
- Mitral valve prolapse
- Pulmonary hypertension
- Peptic ulcer disease
- Oesophageal spasm
- Acute cholecystitis
- Acute pancreatitis
- Herpes zoster
James E. Brown, MD, MMM
Professor and Chair
Wright State University Boonshoft School of Medicine
JEB declares that he has given expert testimony in matters related to this topic.
Dr James E. Brown would like to gratefully acknowledge Dr Marvin H. Eng and Dr Mori J. Krantz, previous contributors to this topic.
MHE declares that he has no competing interests. MJK is a consultant for GlaxoSmithKline.
Michael Jelinek, MD, FRACP, FACC
St Vincent’s Hospital Melbourne
Department of Medicine
University of Melbourne
MJ declares that he has no competing interests.
Debabrata Mukherjee, MD
Gill Foundation Professor of Interventional Cardiology
Director of Cardiac Catheterization Laboratories
Gill Heart Institute
Division of Cardiovascular Medicine
University of Kentucky
DM declares that he has no competing interests.
Martin Bocks, MD
University of Michigan Congenital Heart Center
MB declares that he has no competing interests.
Ethan Cumbler, MD
Department of Internal Medicine
University of Colorado Health Sciences Center
EC declares that he has no competing interests.
Davendra P.S. Sohal, MBBS, MPH
Albert Einstein College of Medicine/Jacobi Medical Center
DS declares that he has no competing interests.
- ACR appropriateness criteria: suspected pulmonary embolism
- ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease
Needle decompression of tension pneumothorax animated demonstration
Venepuncture and phlebotomy animated demonstrationMore videos
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer