Chest pain is a common reason for emergency room visits. According to the document, chest pain accounts for over 2 million ER visits per year in the US. It can be difficult to accurately diagnose the underlying cause of chest pain. The document discusses several cases of patients presenting with chest pain and provides diagnostics and treatments for common conditions that cause chest pain, such as myocardial infarction, pericarditis, pulmonary embolism, aortic dissection, costochondritis, and gastroesophageal reflux disease. A thorough patient history and physical exam, along with diagnostic tests, are important for correctly identifying the source of a patient's chest pain.
10. The importance of a history Swap JAMA 2005 1.9 Worse than previous angina or similar to previous MI 1.8 Described as pressure 2.0 Associated with nausea or vomiting 2.3 Radiation to left arm 2.4 Associated with exertion 4.1 Radiation to both arms or shoulder 4.7 Radiation to R arm or shoulder Positive likelihood ratio Pain Descriptor
11. The importance of a history Swap JAMA 2005 0.8 Not associated with exertion 0.3 Reproducible with palpation 0.3 Described as sharp 0.3 Described as positional 0.2 Describes as pleuritic Positive likelihood ratio Pain Descriptor
38. Case # 5 A 52-year-old man telephones his physician to report a 4-week history of episodic left-sided chest pain lasting 3 to 5 minutes, often occurring at rest, and resolving spontaneously. He is unsure whether the episodes are related to meals. He has not had any shortness of breath, orthopnea, exertional dyspnea, nausea or vomiting. History is significant for hyperlipidemia. Patient has been sedentary for the past several years until 3 months ago when he began exercising. The patient is experiencing significant stress related to his job; he is also in the midst of a divorce. During the course of the phone interview, the patient is asked to determine whether he feels any pain while pressing on his chest over the lateral aspects of the sternum. The patient reports that this maneuver does vaguely reproduce his pain.