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
- Esophageal spasm
- Acute cholecystitis
- Acute pancreatitis
- Herpes zoster
- Gastritis
- E-cigarette or Vaping product use Associated Lung injury (EVALI)
- Vasospastic angina
- Spontaneous coronary artery dissection (SCAD)
Contributors
Authors
David Winchester, MD, MS
Professor of Medicine and Radiology
University of Florida College of Medicine
Gainesville, FL
Disclosures
DW declares that he serves on the Board of Trustees of the American College of Cardiology and is a member of the Board of Directors of the American Society of Nuclear Cardiology.
Eduardo J Perez, MD, FACC
Assistant Professor of Medicine
Division of Cardiovascular Medicine
College of Medicine
Gainesville, FL
Disclosures
EJP declares that he has no conflicting interests.
Acknowledgements
Dr David Winchester and Dr Eduardo J Perez would like to gratefully acknowledge Dr James E. Brown, Dr Marvin H. Eng, and Dr Mori J. Krantz, previous contributors to this topic.
Disclosures
JEB declares that he has given expert testimony in matters related to this topic. MHE declares that he has no competing interests. MJK is a consultant for GlaxoSmithKline.
Peer reviewers
Debabrata Mukherjee, MD
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.
Martin Bocks, MD
Clinical Lecturer
University of Michigan Congenital Heart Center
Ann Arbor, MI
Disclosures
MB declares that he has no competing interests.
Ethan Cumbler, MD
Assistant Professor
Department of Internal Medicine
University of Colorado Health Sciences Center
Denver, CO
Disclosures
EC declares that he has no competing interests.
Davendra P.S. Sohal, MBBS, MPH
Research Fellow
Internal Medicine
Albert Einstein College of Medicine/Jacobi Medical Center
Bronx, NY
Disclosures
DS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2021 Nov 30;144(22):e368-454.Full text Abstract
Rao SV, O'Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2025 Apr;151(13):e771-e862.Full text Abstract
National Institute for Health and Care Excellence. Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis. Nov 2016 [internet publication].Full text
Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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