Chest pain

Chest pain is common. The challenge facing the clinician is to develop a management strategy that will quickly allow the identification of those patients with serious pathology from the majority of patients with conditions that can be readily and safely managed in the community. Given the incidence of ischaemic heart disease and the risks associated with missing the diagnosis, it is all too possible for doctors to become blinkered to alternative and serious causes of chest pain, e.g. aortic dissection, once a cardiac problem has been ruled out. An ideal approach to the management of patients with chest pain is one which recognizes the limitations of the assessment tools, e.g. history, examination and electrocardiogram (ECG), identifies those patients with serious disease, and maximizes the number of patients safely allowed home whilst minimizing the number of patients discharged with the label ‘non-cardiac’ chest pain. This article will cover the identification and management of the common causes of chest pain.