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)
- 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
#ChestPain #ACS #Algorithm #Angina #diagnosis #management #cardiology #differential