Chest pain

Jeffrey A. Tabas, Susan Promes

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Scope of the problem Acute chest pain is the presenting complaint in roughly 3% of emergency department (ED) patients. The diagnostic possibilities range from the immediately life-threatening (acute coronary syndrome [ACS], comprised of acute myocardial infarction [AMI] and unstable angina [USA], aortic dissection, pulmonary embolism [PE] and ruptured esophagus) to the self-limiting (chest wall strain), and the common (gastroesophageal reflux disease) to the unusual (herpes zoster). Although the etiology of the chest pain may remain unidentified in a significant proportion of patients, which can be frustrating to both the patient and provider, it is imperative that the clinician recognizes and treats life-threatening causes. Anatomic essentials When considering the differential diagnosis of the patient with chest pain, it is helpful to consider the five organ systems in the thorax: cardiac (heart and pericardium), pulmonary (lungs and pleura), gastrointestinal (esophagus and upper abdominal contents), vascular (aorta and great vessels) and musculoskeletal (chest wall). Visceral pain from internal structures such as the heart, lungs, esophagus and aorta may be difficult for the patient to define. Pain may be described as a discomfort or strange sensation, and it is often challenging for the patient to discern an exact location. Somatic pain from chest wall structures is often more localizable and easier for the patient to characterize. Pain may be sharp or stabbing, brought on by movement or position, and can often be pinpointed. Referred pain from irritation or inflammation of the upper abdominal contents may be perceived as pain in the chest or upper back. A differential diagnosis based on these structures is given in Table 17.1.

Original languageEnglish (US)
Title of host publicationAn Introduction to Clinical Emergency Medicine
PublisherCambridge University Press
Pages221-235
Number of pages15
ISBN (Electronic)9780511852091
ISBN (Print)9780521747769
DOIs
StatePublished - Jan 1 2012

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Chest Pain
Thoracic Wall
Esophagus
Lung
Aorta
Differential Diagnosis
Visceral Pain
Referred Pain
Nociceptive Pain
Pain
Pleura
Pericardium
Unstable Angina
Herpes Zoster
Acute Pain
Acute Coronary Syndrome
Gastroesophageal Reflux
Pulmonary Embolism
Blood Vessels
Dissection

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Tabas, J. A., & Promes, S. (2012). Chest pain. In An Introduction to Clinical Emergency Medicine (pp. 221-235). Cambridge University Press. https://doi.org/10.1017/CBO9780511852091.023
Tabas, Jeffrey A. ; Promes, Susan. / Chest pain. An Introduction to Clinical Emergency Medicine. Cambridge University Press, 2012. pp. 221-235
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Tabas, JA & Promes, S 2012, Chest pain. in An Introduction to Clinical Emergency Medicine. Cambridge University Press, pp. 221-235. https://doi.org/10.1017/CBO9780511852091.023

Chest pain. / Tabas, Jeffrey A.; Promes, Susan.

An Introduction to Clinical Emergency Medicine. Cambridge University Press, 2012. p. 221-235.

Research output: Chapter in Book/Report/Conference proceedingChapter

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Tabas JA, Promes S. Chest pain. In An Introduction to Clinical Emergency Medicine. Cambridge University Press. 2012. p. 221-235 https://doi.org/10.1017/CBO9780511852091.023