Approach to chest pain

1. Approach to chest pain

2. Chest pain can be picked up by
stethoscope

3. CHEST PAIN
Musculoskeletal :30-50%
Gastrointestinal :10 to 20%
Stable angina:10%
Respiratory :5%
ACS :4%

5. Angina

6. Angina is referred to dermatomes
(C5-6 and T1-T6) that supply afferent
nerves to the same segments of the
spinal cord as the heart
radiates to other parts of the body,
including the upper abdomen
(epigastric), shoulders, arms (upper
and forearm), wrist, fingers, neck and
throat, lower jaw and teeth (but not
upper jaw), and rarely to the back
(specifically the interscapular region)
Radiation to both arms is a stronger
predictor of acute myocardial
infarction
The location and radiation of angina
is usually the same each time

8. Pain is sometimes there