FIVE LIFE THREATENING CAUSES OF CHEST PAIN: PRESENTATION AND DIAGNOSIS

CONDITION	LOCATION OF PAIN	QUALITY OF PAIN	ONSET/DURATION OF PAIN	AGGRAVATING/RELIEVING	SIGNS OR SYMPTOMS	DIAGNOSING THE CONDITION
Myocardial Infarction/Unstable Angina	Substernal may radiate to jaw, neck or shoulder	Pressure, heaviness, squeezing, burning	Builds over several mins to hours	Unable to relieve	SOB, diaphoresis, Nausea, Vomiting, dizziness, lightheadedness	Serial CPKs, ECG. May need LDHs if pain > 24 hours. CLINICAL DIAGNOSIS
Pneumothorax	Unilateral	Sharp, pleuritic	Sudden onset	Painful breathing	Dyspnea; decreased breath sounds; tracheal deviation and tachypnea with tension pneumothorax	Chest x-ray and physicial exam
Pericarditis (Pericardial Tamponade)	Retrosternal and left precordial	Sharp, stabbing, pleuritic	Hours to days	Worse with deep breaths or supine position; better by upright and forward position	Friction rub, pulsus paradoxus, tamponade	ECG; ECHO to rule out tamponade. Consider CXR
Pulmonary Embolus	Substernal	Pleuritic	Sudden onset	Worse with breathing	Dyspnea, tachypnea, tachycardia, rales, hemoptysis	ABG, ECG, Ventilation/Perfusion scan, Pulmonary angiogram
Aortic Dissection	Anterior chest with radiation to back	Severe pain, tearing sensation	Sudden onset	Unable to relieve	Lower BP in arm, decreased femoral pulses, AR murmur, pulsus paradoxus	Chest x-ray (widened mediastinum), angiography, CT or MRI