Chest pain

Clinical features of common causes of chest pain


AnginaOesphageal painDissecting aortic aneurysmMusculoskeletal painPulmonary embolus
HistoryExertional chest pain with dyspnoea and sweating. Relieved by rest or nitrate.Pain worse with swallowing or change in posture. History of acid reflux.Sudden tearing or sharp pain which may move when it recurs.Previous unusual exertion or injurySudden dyspnoea or syncope. Pleuritic chest pain.
Radiation of painAcross chest, jaw and arms especially left.Across chest, sometimes to arms and backBackVariable radiation usually localised.May radiate to shoulder tip if diaphragmatic.
InspectionNitrate spray at bedside. Fists clenched to chest when describing pain (Levine's sign).Tooth enamel erosionPallor, shock.Dyspnoea
PalpationUnequal pulse / BP in arms. Carotid / chest thrill.Localised tenderness
AuscultationMay have bruits / aortic regurgitation.Pleural rub
ECGST depression, T wave inversionNormalSinus tachycardia, ST-T changes, can present with ST elevation and MI.NormalSinus tachycardia, S1Q3T3 pattern, RV 'strain'
CXRNormal unless associated LVF.NormalWidening of the mediastinum. "Calcium sign".NormalRegional oligaemia (Westermark sign), pleural effusion, enlarged pulmonary artery (Fleishner sign), peripheral wedge (infarction).
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Loss of consciousness | Endocarditis | Valvular heart disease | Eponymous cardiac murmurs | Hypertensive retinopathy |