Chest Pain

Disorder Typical Characteristics & Diagnostic Studies
Cardiac Causes
ACS
(15–25% of chest pain in ED)
Substernal “pressure” (⊕ LR 1.3) → neck, jaw, arm (⊕ LR 1.3–1.5)
Sharp, pleuritic, positional, or reprod. w/ palp all w/ ⊕ LR ≤0.35
Diaphoresis (⊕ LR 1.4), dyspnea (⊕ LR 1.2), a/w exertion (⊕ LR 1.5–1.8)
≈ prior MI (⊕ LR 2.2); ↓ w/ NTG/rest (but not reliable; Annals EM 2005;45:581)
± ECG ∆s: STE, STD, TWI, Qw. ± ↑ Troponin.
Pericarditis & myopericarditis Sharp pain → trapezius, ↑ w/ respiration, ↓ w/ sitting forward. ite in aVR) ± pericardial effusion. If myocarditis, same as above + ↑ Tn and ± s/s HF and ↓ EF.