Evaluation of chest pain

Chest pain is a common chief complaint, accounting for approximately 5.4% of all emergency department visits in the US per year.[1]Cairns C, Kang K. National hospital ambulatory medical care survey: 2022 emergency department summary tables [internet publication]. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2022-nhamcs-ed-web-tables.pdf It is the presenting complaint in approximately 0.5% of primary care 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 ​​

Chest pain may be caused by either benign or life-threatening etiologies and can be due to cardiac and noncardiac causes. Within the scope of cardiac causes, one of the key differentiations is determining if symptoms are ischemic or nonischemic in origin.

Life threatening etiologies of chest pain include acute coronary syndrome (ACS; encompassing unstable angina, ST-elevation myocardial infarction, and non-ST-elevation myocardial infarction), aortic dissection, and pulmonary embolus. Because diagnoses vary depending on the presentation setting, these may not be the most common diagnoses in patients presenting with chest pain. Excluding life-threatening diagnoses, however, is vital and should be a primary concern regardless of where a patient presents.

This topic concentrates on the evaluation of acute chest pain.