Assessment of chest pain

Chest pain is a common chief complaint, accounting for approximately 5.6% of all emergency department visits in the US per year.[1]Cairns C, Kang K. National hospital ambulatory medical care survey: 2021 emergency department summary tables. 2021 [internet publication]. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc21-ed-508.pdf It is the presenting complaint in approximately 0.5% of clinic-based visits.[2]Centers for Disease Control and Prevention. National Center for Health Statistics: survey results and products - 2019 national ambulatory medical care survey summary tables. Aug 2023 [internet publication]. https://stacks.cdc.gov/view/cdc/123251 ​ In the UK, 1% to 2% of adults attend primary care each year with a new presentation of chest pain.[3]Ruigomez A, Rodriguez LA, Wallander MA, et al. Chest pain in general practice: incidence, comorbidity and mortality. Fam Pract. 2006 Apr;23(2):167-74. https://academic.oup.com/fampra/article/23/2/167/527348 http://www.ncbi.nlm.nih.gov/pubmed/16461444?tool=bestpractice.com [4]Walters K, Rait G, Hardoon S, et al. Socio-demographic variation in chest pain incidence and subsequent coronary heart disease in primary care in the United Kingdom. Eur J Prev Cardiol. 2014 May;21(5):566-75. http://www.ncbi.nlm.nih.gov/pubmed/22617118?tool=bestpractice.com [5]Ruigómez A, Massó-González EL, Johansson S, et al. Chest pain without established ischaemic heart disease in primary care patients: associated comorbidities and mortality. Br J Gen Pract. 2009 Mar;59(560):e78-86. http://bjgp.org/content/59/560/e78.long http://www.ncbi.nlm.nih.gov/pubmed/19275827?tool=bestpractice.com ​​ 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.[6]Hoorweg BB, Willemsen RT, Cleef LE, et al. Frequency of chest pain in primary care, diagnostic tests performed and final diagnoses. Heart. 2017 Nov;103(21):1727-32. http://www.ncbi.nlm.nih.gov/pubmed/28634285?tool=bestpractice.com

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. Excluding ACS is, however, vital because of the mortality associated with untreated myocardial infarction.

This topic concentrates on the assessment of acute chest pain in the emergency setting.