Chest Pain Differential Diagnosis Algorithm 
 • Stable ...
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Chest Pain Differential Diagnosis Algorithm 

 • Stable Angina/ACS

     - Intermediate Risk: Radiation to left arm, neck, or jaw (1.3-1.5), Diaphoresis (1.4), Exertional (1.5), Pressure/typical (1.9), Pattern change/24h (2.0)

     - High Risk: Similar to prior ischemia (2.2), Pain radiating to both arms (2.6), PAD (2.7) Abnormal prior, stress test (3.1)

 • Acute Aortic Syndromes - Abrupt onset of tearing/sharp/ripping thoracic or abdominal pain, known aneurysm, Marfan syndrome, HTN. Men 2x > women, age 60s-80s, cocaine use, high-intensity exertion (weight lifting). 

 • Acute Pericarditis - Pleuritic, sharp, improves upon leaning forward. May have URI prodrome, though consider bacterial pericarditis if high fevers.

 • PE - Sudden onset, dyspnea/hypoxemia, pleuritic, hx of cancer/recent surgery/immobility, +/- TnT

 • Pneumothorax - Sudden onset, 20-40 yo (spontaneous and more likely if tall), family or personal history, smoker, known emphysema, men > women, recent chest procedures/lines.

 • Pneumonia/ pneumonitis - Sharp, pleuritic CP associated with fever/leukocytosis, productive cough, recent

radiation, autoimmune (SLE, RA, drug-induced lupus, collagen vascular diseases)

 • Other: 

     - Cardiac: HOCM, AS, vasospasm (Prinzmetal’s angina or drug/toxin), Takotsubo CM, cardiac syndrome X;           

     - MSK: Costochondritis, Zoster; 

     - GI: GERD, esophageal spasm (may be relieved by TNG), Boerhaave’s, PUD, biliary colic, pancreatitis; 

     - Psych: panic attack



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