A client with chest pain is diagnosed with acute pericarditis by the health care provider

Review

. 2013 Feb 1;87(3):177-82.

Affiliations

• PMID: 23418761

Free article

Review

Outpatient diagnosis of acute chest pain in adults

John R McConaghy et al. Am Fam Physician. 2013.

Free article

Abstract

Approximately 1 percent of primary care office visits are for chest pain, and 1.5 percent of these patients will have unstable angina or acute myocardial infarction. The initial goal in patients presenting with chest pain is to determine if the patient needs to be referred for further testing to rule in or out acute coronary syndrome and myocardial infarction. The physician should consider patient characteristics and risk factors to help determine initial risk. Twelve-lead electrocardiography is typically the test of choice when looking for ST segment changes, new-onset left bundle branch block, presence of Q waves, and new-onset T wave inversions. For persons in whom the suspicion for ischemia is lower, other diagnoses to consider include chest wall pain/costochondritis (localized pain reproducible by palpation), gastroesophageal reflux disease (burning retrosternal pain, acid regurgitation, and a sour or bitter taste in the mouth), and panic disorder/anxiety state. Other less common but important diagnostic considerations include pneumonia (fever, egophony, and dullness to percussion), heart failure, pulmonary embolism (consider using the Wells criteria), acute pericarditis, and acute thoracic aortic dissection (acute chest or back pain with a pulse differential in the upper extremities). Persons with a higher likelihood of acute coronary syndrome should be referred to the emergency department or hospital.

Similar articles

• Acute Chest Pain in Adults: Outpatient Evaluation.

  McConaghy JR, Sharma M, Patel H. McConaghy JR, et al. Am Fam Physician. 2020 Dec 15;102(12):721-727. Am Fam Physician. 2020. PMID: 33320506

• High-risk chief complaints I: chest pain--the big three.

  Woo KM, Schneider JI. Woo KM, et al. Emerg Med Clin North Am. 2009 Nov;27(4):685-712, x. doi: 10.1016/j.emc.2009.07.007. Emerg Med Clin North Am. 2009. PMID: 19932401 Review.

• Costochondritis: diagnosis and treatment.

  Proulx AM, Zryd TW. Proulx AM, et al. Am Fam Physician. 2009 Sep 15;80(6):617-20. Am Fam Physician. 2009. PMID: 19817327

• Prevalence of acute myocardial infarction and other serious diagnoses in patients presenting to an urban emergency department with chest pain.

  Kohn MA, Kwan E, Gupta M, Tabas JA. Kohn MA, et al. J Emerg Med. 2005 Nov;29(4):383-90. doi: 10.1016/j.jemermed.2005.04.010. J Emerg Med. 2005. PMID: 16243193

• [Chest pain: diagnostic trends].

  Krempf M, Merault JM. Krempf M, et al. Rev Prat. 1998 Sep 1;48(13):1491-5. Rev Prat. 1998. PMID: 10050635 Review. French. No abstract available.

Cited by

• Associations between mental health disorder and management of physical chronic conditions in China: a pooled cross-sectional analysis.

  Zhang Z, Sum G, Qin VM, Zhao Y, Haregu TN, Oldenburg B, Lee JT. Zhang Z, et al. Sci Rep. 2021 Mar 11;11(1):5731. doi: 10.1038/s41598-021-85126-4. Sci Rep. 2021. PMID: 33707604 Free PMC article.

• Performance of a simplified HEART score and HEART-GP score for evaluating chest pain in urgent primary care.

  Harskamp RE, Kleton M, Smits IH, Manten A, Himmelreich JCL, van Weert HCPM, Rietveld RP, Lucassen WAM. Harskamp RE, et al. Neth Heart J. 2021 Jun;29(6):338-347. doi: 10.1007/s12471-020-01529-4. Epub 2021 Jan 6. Neth Heart J. 2021. PMID: 33405015 Free PMC article.

• Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study.

  Kauppi W, Herlitz J, Magnusson C, Palmér L, Axelsson C. Kauppi W, et al. BMC Emerg Med. 2020 Aug 28;20(1):67. doi: 10.1186/s12873-020-00363-6. BMC Emerg Med. 2020. PMID: 32859155 Free PMC article.

• Rationale and design of a cohort study evaluating triage of acute chest pain in out-of-hours primary care in the Netherlands (TRACE).

  Manten A, Cuijpers CJJ, Rietveld R, Groot E, van de Graaf F, Voerman S, Himmelreich JCL, Lucassen WAM, van Weert HCPM, Harskamp RE. Manten A, et al. Prim Health Care Res Dev. 2020 May 8;21:e10. doi: 10.1017/S1463423620000122. Prim Health Care Res Dev. 2020. PMID: 32383424 Free PMC article.

• Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries.

  Sum G, Koh GC, Mercer SW, Wei LY, Majeed A, Oldenburg B, Lee JT. Sum G, et al. BMC Public Health. 2020 Jan 6;20(1):9. doi: 10.1186/s12889-019-8112-3. BMC Public Health. 2020. PMID: 31906907 Free PMC article.

Publication types

MeSH terms

LinkOut - more resources

• Full Text Sources

  • American Academy of Family Physicians
  • ClinicalKey
  • Elsevier Science

• Medical

  • MedlinePlus Health Information