Chest pain resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Rim Halaby

Definition

Chest pain is discomfort or pain that is felt anywhere along the front of the body between the neck and the upper abdomen.

Causes

Immediate Life-Threatening Causes

Immediate life-threatening causes are conditions which result in immediate death or disability if left untreated.

Other Common Causes

Management

Please find below an algorithm that summarizes the approach to chest pain.

 
 
 
 
 
 
 
 
Check vital signs
Stabilize the patient
Order an EKG
Concise history and physical exam
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess EKG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EKG consistent with ACS
 
 
 
 
 
 
 
 
 
 
EKG not consistent with ACS
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order a CXR
 
 
 
 
 
 
 
 
STEMI
Revascularization
 
 
NSTEMI
Risk stratification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pneumothorax
 
 
 
Aortic dissection
 
 
 
No significant findings on CXR
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Control BP
Obtain a CT scan
Emergent surgery consult
 
 
 
Assess the pretest probability
for pulmonary embolism
 

Do's and Don'ts

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