| CAUSES | HISTORY | EXAMINATION | INVESTIGATION |
| Coronary syndrome | Central crushing, squeezing chest pain or heaviness
radiating to epigastrium, shoulder, arm, neck or jaw. Associated with sweatiness,
nausea or dyspnea. (These symptoms may occur in isolation without chest pain) Cardiac risk factors e.g. hypertension, diabetes, hyperlipidaemia, smoking, positive family history |
May be normal. Tachycardia, Fourth Heart sound. | ECG - May be normal. ST/T changes |
| Pulmonary Embolism | Sudden onset chest pain with dyspnoea or haemoptysis. Risk factors for DVT e.g. recent surgery, bed rest, prolonged travel, previous DVT/PE, malignancy |
Often normal. Tachypnoea. Tachycardia | ECG - sinus tachycardia, atrial fibrillation, 'S1Q3T3',
dominant R in V1, RBBB ABG - hypoxia or wide A-a gradient CXR - usually normal V/Q scan - V/Q mismatching CT chest - perfusion defects |
| Dissecting aortic aneurysm | Sudden onset chest pain radiating through to back. May be associated with syncope. | Often hypertensive. Differential BP in both arms > 20mmHg. Aortic regurgitant murmur | CXR - may be normal, widened mediastinum CT chest - mediastinal haematoma, false aortic lumen |