Medical Council of Canada

Medical expert

Chest Pain - 14

Rationale

Chest pain is a very common clinical presentation with a spectrum of underlying causes ranging from benign to life-threatening.

Causal Conditions

(list not exhaustive)
  1. Cardiovascular
    1. Ischemic
      1. Acute coronary syndromes
      2. Stable angina pectoris
    2. Non-ischemic
      1. Aortic aneurysm
      2. Pericarditis
  2. Pulmonary or mediastinal
    1. Pulmonary embolus or pulmonary infarct
    2. Pleuritis
    3. Pneumothorax
    4. Malignancy
  3. Gastro-intestinal
    1. Esophageal spasm or esophagitis
    2. Peptic ulcer disease
    3. Mallory-Weiss syndrome
    4. Biliary disease or pancreatitis
  4. Anxiety disorders
  5. Chest wall pain (e.g., costochondritis)

Key Objectives

Given a patient who presents with chest pain, the candidate will diagnose the cause and severity, with particular attention to excluding life-threatening diagnoses.

Enabling Objectives

Given the patient with chest pain, the candidate will

  1. list and interpret critical clinical findings, including
    1. differentiate cardiac from non-cardiac pain;
    2. determine the presence of cardiac risk factors;
    3. recognize that serious cardiovascular disease may present atypically;
    4. perform and interpret an appropriate physical examination;
  2. list and interpret critical investigations, including
    1. interpret electrocardiogram (ECG) and appropriate laboratory tests;
    2. select, as appropriate, patients for additional investigations (e.g., stress testing, imaging);
  3. construct an effective initial management plan, including
    1. determine urgency of clinical condition;
    2. initiate appropriate therapies in urgent situations (e.g., acute coronary syndrome, aortic dissection);
    3. refer for urgent specialized care, as required;
    4. initiate secondary preventive strategies as indicated.
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