Skip to main content
SpringerLink
Log in

Chest Pain

  • Chapter
  • First Online:
Handbook of Outpatient Cardiology

  • 1280 Accesses

Abstract

A thorough history and physical assessment is key to differentiating cardiac and non-cardiac etiologies of chest pain in the outpatient setting. The most common causes of chest pain are non-cardiac and include musculoskeletal and gastroesophageal disorders. Cardiac chest pain is less common than non-cardiac chest pain, but is associated with higher morbidity and mortality. It includes acute coronary syndrome, valvular disease, and pericardial disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ACS:

Acute coronary syndrome

ASCVD:

Atherosclerotic cardiovascular disease

CAD:

Coronary artery disease

CP:

Chest pain

DVT:

Deep vein thrombosis

ECG:

Electrocardiogram

GERD:

Gastroesophageal reflux disease

H&P:

History and physical

HCM:

Hypertrophic cardiomyopathy

MI:

Myocardial infarction

PCP:

Primary care physician

PE:

Pulmonary embolism

PMH:

Past medical history

References

  1. Bosner S, Becker A, Haasenritter J, et al. Chest pain in primary care: epidemiology and pre-work-up probabilities. Eur J Gen Pract. 2009;15(3):141–6.

    Article  PubMed  Google Scholar 

  2. Svavarsdottir AE, Jonasson MR, Gudmundsson GH, Fjeldsted K. Chest pain in family practice. Diagnosis and long-term outcome in a community setting. Can Fam Physician. 1996;42:1122–8.

    CAS  PubMed  Google Scholar 

  3. Klinkman MS, Stevens D, Gorenflo DW. Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network. J Fam Pract. 1994;38(4):345–52.

    CAS  PubMed  Google Scholar 

  4. Bosner S, Haasenritter J, Becker A, et al. Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule. CMAJ. 2010;182(12):1295–300.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lacasse M, Maker D. Fishing and history taking: from the net to the line. Can Fam Physician. 2008;54(6):891–2.

    PubMed  PubMed Central  Google Scholar 

  6. Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA. 2005;294(20):2623–9.

    Article  CAS  PubMed  Google Scholar 

  7. Fanaroff AC, Rymer JA, Goldstein SA, Simel DL, Newby LK. Does this patient with chest pain have acute coronary syndrome?: the rational clinical examination systematic review. JAMA. 2015;314(18):1955–65.

    Article  CAS  PubMed  Google Scholar 

  8. Diamond GA, Staniloff HM, Forrester JS, Pollock BH, Swan HJ. Computer-assisted diagnosis in the noninvasive evaluation of patients with suspected coronary artery disease. J Am Coll Cardiol. 1983;1(2 Pt 1):444–55.

    Article  CAS  PubMed  Google Scholar 

  9. Hedayati T, Yadav N, Khanagavi J. Non-ST-segment acute coronary syndromes. Cardiol Clin. 2018;36(1):37–52.

    Article  PubMed  Google Scholar 

  10. Rouan GW, Lee TH, Cook EF, Brand DA, Weisberg MC, Goldman L. Clinical characteristics and outcome of acute myocardial infarction in patients with initially normal or nonspecific electrocardiograms (a report from the Multicenter Chest Pain Study). Am J Cardiol. 1989;64(18):1087–92.

    Article  CAS  PubMed  Google Scholar 

  11. Eriksson D, Khoshnood A, Larsson D, Lundager-Forberg J, Mokhtari A, Ekelund U. Diagnostic accuracy of history and physical examination for predicting major adverse cardiac events within 30 days in patients with acute chest pain. J Emerg Med. 2019;S0736-4679(19):30828–5.

    Google Scholar 

  12. Goodacre S, Locker T, Morris F, Campbell S. How useful are clinical features in the diagnosis of acute, undifferentiated chest pain? Acad Emerg Med. 2002;9(3):203–8.

    Article  PubMed  Google Scholar 

  13. Bruyninckx R, Aertgeerts B, Bruyninckx P, Buntinx F. Signs and symptoms in diagnosing acute myocardial infarction and acute coronary syndrome: a diagnostic meta-analysis. Br J Gen Pract. 2008;58(547):105–11.

    Article  PubMed  Google Scholar 

  14. Verdon F, Herzig L, Burnand B, et al. Chest pain in daily practice: occurrence, causes and management. Swiss Med Wkly. 2008;138(23–24):340–7.

    PubMed  Google Scholar 

  15. Han JH, Lindsell CJ, Storrow AB, et al. The role of cardiac risk factor burden in diagnosing acute coronary syndromes in the emergency department setting. Ann Emerg Med. 2007;49(2):145–52, 152 e141.

    Article  PubMed  Google Scholar 

  16. Body R, Carley S, Wibberley C, McDowell G, Ferguson J, Mackway-Jones K. The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes. Resuscitation. 2010;81(3):281–6.

    Article  PubMed  Google Scholar 

  17. Marcus GM, Cohen J, Varosy PD, et al. The utility of gestures in patients with chest discomfort. Am J Med. 2007;120(1):83–9.

    Article  PubMed  Google Scholar 

  18. D’Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743–53.

    Article  PubMed  Google Scholar 

  19. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283(7):897–903.

    Article  CAS  PubMed  Google Scholar 

  20. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol. 2015;66(4):350–8.

    Article  PubMed  Google Scholar 

  21. Clouse WD, Hallett JW Jr, Schaff HV, et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc. 2004;79(2):176–80.

    Article  PubMed  Google Scholar 

  22. Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013;127(20):2031–7.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Olsson C, Thelin S, Stahle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation. 2006;114(24):2611–8.

    Article  PubMed  Google Scholar 

  24. Spodick DH. Pericardial rub. Prospective, multiple observer investigation of pericardial friction in 100 patients. Am J Cardiol. 1975;35(3):357–62.

    Article  CAS  PubMed  Google Scholar 

  25. Bashore TM, Granger CB, Jackson KP, Patel MR. Pericardial effusion & tamponade. In: Papadakis MA, McPhee SJ, Rabow MW, editors. Current medical diagnosis & treatment 2021. New York: McGraw-Hill Education; 2021.

    Google Scholar 

  26. Nadler PL, Gonzales R. Chest pain. In: Papadakis MA, McPhee SJ, Rabow MW, editors. Current medical diagnosis & treatment 2021. New York: McGraw-Hill Education; 2021.

    Google Scholar 

  27. Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000;83(3):416–20.

    Article  CAS  PubMed  Google Scholar 

  28. O’Gara PT, Loscalzo J. Aortic valve disease. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison’s principles of internal medicine. 20th ed. New York: McGraw-Hill Education; 2018.

    Google Scholar 

  29. O’Gara PT, Loscalzo J. Mitral Valve Prolapse. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison’s principles of internal medicine. 20th ed. New York: McGraw-Hill Education; 2018.

    Google Scholar 

  30. Ananthasubramaniam K. Hypertrophic cardiomyopathy. In: Crawford MH, editor. Current diagnosis & treatment: cardiology. 5th ed. New York: McGraw-Hill Education; 2017.

    Google Scholar 

  31. Bosner S, Becker A, Hani MA, et al. Chest wall syndrome in primary care patients with chest pain: presentation, associated features and diagnosis. Fam Pract. 2010;27(4):363–9.

    Article  PubMed  Google Scholar 

  32. Verdon F, Burnand B, Herzig L, Junod M, Pécoud A, Favrat B. Chest wall syndrome among primary care patients: a cohort study. BMC Fam Pract. 2007;8(1):51.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shrestha S, Pasricha PJ. Update on noncardiac chest pain. Dig Dis. 2000;18(3):138–46.

    Article  CAS  PubMed  Google Scholar 

  34. Galmiche JP, Clouse RE, Balint A, et al. Functional esophageal disorders. Gastroenterology. 2006;130(5):1459–65.

    Article  PubMed  Google Scholar 

  35. Eslick GD, Jones MP, Talley NJ. Non-cardiac chest pain: prevalence, risk factors, impact and consulting – a population-based study. Aliment Pharmacol Ther. 2003;17(9):1115–24.

    Article  CAS  PubMed  Google Scholar 

  36. Wong WM, Lai KC, Lau CP, et al. Upper gastrointestinal evaluation of Chinese patients with non-cardiac chest pain. Aliment Pharmacol Ther. 2002;16(3):465–71.

    Article  PubMed  Google Scholar 

  37. Zimmerman J. Validation of a brief inventory for diagnosis and monitoring of symptomatic gastro-oesophageal reflux. Scand J Gastroenterol. 2004;39(3):212–6.

    Article  CAS  PubMed  Google Scholar 

  38. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus G. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900–20; quiz 1943.

    Article  PubMed  Google Scholar 

  39. Eusebi LH, Ratnakumaran R, Yuan Y, Solaymani-Dodaran M, Bazzoli F, Ford AC. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut. 2018;67(3):430–40.

    Article  PubMed  Google Scholar 

  40. Eslick GD, Coulshed DS, Talley NJ. Diagnosis and treatment of noncardiac chest pain. Nat Clin Pract Gastroenterol Hepatol. 2005;2(10):463–72.

    Article  PubMed  Google Scholar 

  41. Fang J, Bjorkman D. A critical approach to noncardiac chest pain: pathophysiology, diagnosis, and treatment. Am J Gastroenterol. 2001;96(4):958–68.

    Article  CAS  PubMed  Google Scholar 

  42. Kahrilas PJ, Smout AJ. Esophageal disorders. Am J Gastroenterol. 2010;105(4):747–56.

    Article  PubMed  Google Scholar 

  43. Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years’ experience with 1161 patients. Ann Intern Med. 1987;106(4):593–7.

    Article  CAS  PubMed  Google Scholar 

  44. Butler KH, Swencki SA. Chest pain: a clinical assessment. Radiol Clin N Am. 2006;44(2):165–79, vii.

    Article  PubMed  Google Scholar 

  45. Reamy BV, Williams PM, Odom MR. Pleuritic chest pain: sorting through the differential diagnosis. Am Fam Physician. 2017;96(5):306–12.

    PubMed  Google Scholar 

  46. Barnett LA, Prior JA, Kadam UT, Jordan KP. Chest pain and shortness of breath in cardiovascular disease: a prospective cohort study in UK primary care. BMJ Open. 2017;7(5):e015857.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Cao W, Fang Z, Hou G, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020;287:112934.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Chapter 27 - Auscultation of the lungs. In: McGee S, editor. Evidence-based physical diagnosis. 2nd ed. Saint Louis: W.B. Saunders; 2007. p. 326–45.

    Google Scholar 

  49. Johnson RW, Rice AS. Clinical practice. Postherpetic neuralgia. N Engl J Med. 2014;371(16):1526–33.

    Article  CAS  PubMed  Google Scholar 

  50. Whitley RJ. Varicella-zoster virus infections. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison’s principles of internal medicine, 20e. New York: McGraw-Hill Education; 2018.

    Google Scholar 

  51. Landenhed M, Engstrom G, Gottsater A, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. J Am Heart Assoc. 2015;4(1):e001513.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Chau KH, Elefteriades JA. Natural history of thoracic aortic aneurysms: size matters, plus moving beyond size. Prog Cardiovasc Dis. 2013;56(1):74–80.

    Article  PubMed  Google Scholar 

  53. Tadros TM, Klein MD, Shapira OM. Ascending aortic dilatation associated with bicuspid aortic valve: pathophysiology, molecular biology, and clinical implications. Circulation. 2009;119(6):880–90.

    Article  PubMed  Google Scholar 

  54. Michelena HI, Khanna AD, Mahoney D, et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA. 2011;306(10):1104–12.

    Article  CAS  PubMed  Google Scholar 

  55. Disla E, Rhim HR, Reddy A, Karten I, Taranta A. Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med. 1994;154(21):2466–9.

    Article  CAS  PubMed  Google Scholar 

  56. Kawai K, Yawn BP. Risk factors for herpes zoster: a systematic review and meta-analysis. Mayo Clin Proc. 2017;92(12):1806–21.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emory University School of Medicine, Atlanta, GA, USA

    Katharine Rainer

  2. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Franck H. Azobou Tonleu

  3. Banner Health, Cardiovascular Institute of Northern Colorado, Greeley, CO, USA

    Mark K. Tuttle

Authors
  1. Katharine Rainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Franck H. Azobou Tonleu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark K. Tuttle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Franck H. Azobou Tonleu .

Editor information

Editors and Affiliations

  1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Ankit A. Bhargava

  2. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Bryan J. Wells

  3. Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Pablo A. Quintero

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rainer, K., Azobou Tonleu, F.H., Tuttle, M.K. (2022). Chest Pain. In: Bhargava, A.A., Wells, B.J., Quintero, P.A. (eds) Handbook of Outpatient Cardiology . Springer, Cham. https://doi.org/10.1007/978-3-030-88953-1_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-88953-1_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-88952-4

  • Online ISBN: 978-3-030-88953-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation