Differentials for Chest Pain

Chest Pain can be due to Skin, Muscle & Bones, Heart, Lungs, or Oesophagus.

If Skin is the cause, it can be due to Herpes zoster/Shingles.

In Muscle & Bones, it can be due to
Trauma due to any cause. For Example, fall, sport, accident, injury.
Costochondritis.

If Heart is the cause, it can be due to:
Myocardial Infarction may be a history of Radiation, Family Hx, or Acute severe pain.
Pericarditis can present with a history of Fever and Pain that is relieved by leaning forward.
Stable Angina is suspected when the patient is not in pain now, and pain arises only on exercise then settle by rest.
Aortic Dissection is suspected when pain radiates to the back in between shoulder blades.

If Lung is the cause, it can be due to:
Pneumonia, the patient presents with a history of fever, cough, and sputum.
Pulmonary Embolism is suspected when there is Travel Hx, recent surgery, calf muscle pain/tenderness and most importantly, use of Combined Oral Contraceptive Pills (COCP).
Pneumothorax is suspected when a young patient has shortness of Breath (SOB) with a history of trauma or accident.

If Oesophagus is the cause, it can be due to:
GORD, Symptoms include heartburn and a sour taste in the mouth due to regurgitation.

How to Rule out the differentials of Chest Pain?
Ask:
Where is the pain?
When did it start?
How is it since then?
Are you in pain right now?
Is pain going anywhere?
Anything that makes it better or worse?
What have you done for this pain so far?
Rate your pain!

About Writer

Asad Arora
Asad Arora

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