Evaluation of the adult with chest pain in the emergency department
- Judd E Hollander, MD
Judd E Hollander, MD
- Professor and Vice Chair Department of Emergency Medicine
- Thomas Jefferson University
- Maureen Chase, MD, MPH
Maureen Chase, MD, MPH
- Assistant Professor of Emergency Medicine
- Harvard Medical School
Chest pain accounts for approximately six million annual visits to emergency departments (ED) in the United States, making chest pain the second most common complaint . Patients present with a spectrum of signs and symptoms reflecting the many potential etiologies of chest pain. Diseases of the heart, aorta, lungs, esophagus, stomach, mediastinum, pleura, and abdominal viscera may all cause chest discomfort.
Clinicians in the ED focus on the immediate recognition and exclusion of life-threatening causes of chest pain. Patients with life-threatening etiologies for chest pain may appear deceptively well, manifesting neither vital sign nor physical examination abnormalities.
This topic review will discuss life-threatening and common causes of chest pain, and provide an approach to the evaluation of chest pain patients in the ED. Detailed discussions of specific causes of chest pain, including the management of a suspected acute coronary syndrome in the ED are found elsewhere. (See "Initial evaluation and management of suspected acute coronary syndrome (myocardial infarction, unstable angina) in the emergency department" and "Overview of acute pulmonary embolism in adults" and "Management of aortic dissection" and "Primary spontaneous pneumothorax in adults" and "Secondary spontaneous pneumothorax in adults" and "Cardiac tamponade" and "Boerhaave syndrome: Effort rupture of the esophagus".)
Life-threatening conditions — Causes of chest pain that pose an immediate threat to life include:
●Acute coronary syndrome
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- DIFFERENTIAL DIAGNOSIS
- Life-threatening conditions
- Common conditions
- General approach
- Onset of pain
- Pain quality and location
- Associated symptoms
- Risk factors
- Prior testing
- PHYSICAL EXAMINATION
- ANCILLARY STUDIES
- Laboratory studies
- Chest radiograph
- Other imaging
- APPROACH TO DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS