Chest Pain – Causes

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  • Assuming the patient is not critically unwell or has ECG findings of a STEMI, then a more systematic history should be taken
  • Chest Pain can arise from several organs: heart, major thoracic vessels. lungs, pleura, chest wall, upper GI tract and the hepato-biliary system
  • Don’t forget the great mimicker, herpes zoster (shingles)
  • It is useful to take a review of systems and PMHx related to the respiratory and digestive system.

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  History Exam Confirmatory Testng
Aortic dissection Abrupt onset of sudden tearing chest pain radiating to interscapular region


Unequal BP in arms (subclavian extension)

Stroke like symptoms (carotid extension)

Bilateral neurological symptoms

(spinal artery extension)

Lower limb ischaemia (descending aorta extension)

Aortic regurgitation

(aortic valve extension)

Shock (pericardial extension)

CT angiogram

(or Trans-oesophageal echocardiogram)

Pulmonary embolism Unexplained hypoxia i.e. chest clear and normal CXR

Wells > 0 or PERC positive


Hypoxia (may be normal)

CTPA or V/Q scan
Gallstones Previous episodes related to food LFTs
Biliary Ultrasound
GOR Previous episodes related to food
Gastric volvulus Prominent vomiting

Abrupt onset of pain

CT abdomen
Boehaaves Abrupt onset of pain Hamman’s crunch
Oesophageal rupture Abrupt onset of pain AXR/CXR
CT abdomen
Herpes Zoster Gradual onset of unexplained unilateral pain or dysthesia Unilateral rash in truncal dermantome
Pneumonia Fever

Productive Cough


Focal chest findings CXR
Pancreatitis Prominent vomiting Epigastric tenderness LFTs
Upper abdominal ultrasound

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