Evaluation of chest pain

Last reviewed: 5 Apr 2025
Last updated: 25 Oct 2024

Summary

Differentials

Common

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

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
Full details

Contributors

Authors

James E. Brown, MD, MMM

Professor and Chair

Emergency Medicine

Wright State University Boonshoft School of Medicine

Fairborn

OH

Disclosures

JEB declares that he has given expert testimony in matters related to this topic.

Acknowledgements

Dr James E. Brown would like to gratefully acknowledge Dr Marvin H. Eng and Dr Mori J. Krantz, previous contributors to this topic.

Disclosures

MHE declares that he has no competing interests. MJK is a consultant for GlaxoSmithKline.

Peer reviewers

Michael Jelinek, MD, FRACP, FACC

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.

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.

References

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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

Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. circulation. 2014 Dec 23;130(25):e344-426.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

O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Jan 29;127(4):e362-425.Full text  Abstract

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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