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Chest pain

Version: March 2022
Legacy ID: 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. Nonischemic
      1. Aortic aneurysm
      2. Pericarditis
  2. Pulmonary or mediastinal
    1. Pulmonary embolus or pulmonary infarction
    2. Pleuritis
    3. Pneumothorax
    4. Malignancy
  3. Gastrointestinal
    1. Esophageal spasm or esophagitis
    2. Peptic ulcer disease
    3. Mallory-Weiss syndrome
    4. Biliary disease or pancreatitis
  4. Musculoskeletal (e.g., costochondritis)
  5. Psychiatric (e.g., anxiety disorders)

Key Objectives

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

Enabling Objectives

Given a patient with chest pain, the candidate will

  1. perform an initial assessment (e.g., ABCs) to determine the urgency of the presentation and need for emergent management;
  2. list and interpret critical clinical findings by obtaining a history and performing a physical examination that aids in
    1. differentiating cardiac from noncardiac pain; and
    2. identifying cardiac risk factors;
  3. list and interpret critical investigations, including
    1. electrocardiograms (ECGs), chest radiographs, and appropriate laboratory tests; and
    2. identifying, as appropriate, patients for additional investigations (e.g., stress testing, imaging); and
  4. construct an effective initial management plan, including
    1. determining urgency of clinical condition;
    2. initiating appropriate therapies in urgent situations (e.g., acute coronary syndrome, aortic dissection, pulmonary embolism, spontaneous pneumothorax);
    3. referring for urgent specialized care as required; and
    4. initiating secondary preventive strategies as indicated.