Chest Pain

Differential Diagnosis of Chest Pain

Introduction.

Patients often associate any chest pain with pain originating from the heart.

Indeed, serious cardiovascular diseases such as acute myocardial infarction or aortic dissection cause chest pain. Chest and thoracic pain, however, can originate from all organs of the thorax. The most serious lung diseases that cause chest pain are massive pulmonary embolism and pneumothorax. Apart from the many cardiac, vascular, and lung diseases, diseases of the gastrointestinal tract and of the musculoskeletal apparatus can also cause chest pain.

Chest pain often induces anxiety in the patient. In addition,

anxiety and emotions are often the causes of chest

pain.

Importance of Medical History and ECG:

A careful medical history, noting the character, duration, and location

of the chest pain, in most cases allows the identification

of the affected organ system (Tab. 6.1). For a more

precise differential diagnosis it is essential to inquire as to

details of pain-precipitating or pain-relieving factors

(e. g., change of pain with change of position) and accompanying                                                                             

symptoms (e. g., nausea, fever, hyperventilation).

An electrocardiogram (ECG) should be taken

early in the evaluation process of unclear chest pain. The

ECG is an important tool to quickly diagnose, or rule out,

acute myocardial ischemia as a cause of chest pain. Establishing

the correct diagnosis, and therefore the correct

cause of chest pain, in a timely fashion is crucial for

initiating the correct therapy.

DIFFERENTIAL DIAGNOSIS OF CHEST PAIN: