Chest Pain

CLINICAL DIAGNOSTIC MANUAL

Chest pain is a common symptom that can range from mild discomfort to a sharp, stabbing sensation. It is a frequent reason for medical consultations and spans a broad spectrum of potential causes, from benign and self-limiting conditions to life-threatening medical emergencies. Its evaluation requires a systematic and detailed approach due to the wide variety of underlying conditions that can present with this symptom.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Myocardial infarction	Crushing pain that may radiate to the arm, jaw, or back, diaphoresis, nausea, palpitations.	Chest pain with typical characteristics and cardiovascular risk factors.	Elevated cardiac enzymes, ECG changes, coronary angiography results.
Angina pectoris	Pressing pain triggered by exertion or stress, relieved by rest.	Recurrent pain during exertion.	Stress tests, echocardiogram, coronary angiography.
Pericarditis	Sharp, stabbing pain, improves when leaning forward, fever, pericardial rub.	Acute chest pain, fever, and signs of inflammation.	ECG showing diffuse ST elevation, echocardiogram, pericardial fluid analysis.
Oesophageal dysfunction	Pain resembling cardiac pain, dysphagia, regurgitation.	Chest pain with food intake or history of oesophageal disorder.	Oesophageal manometry, pH monitoring, endoscopy.
Gastroesophageal reflux (GERD)	Burning pain behind the sternum, acid regurgitation, dysphagia.	Symptoms associated with meals and lying down.	Oesophageal pH monitoring, endoscopy with biopsy.
Oesophageal spasm	Chest pain similar to angina, dysphagia, sensation of food being stuck.	Episodes of chest pain with meals or stress.	Oesophageal manometry, nitroglycerin test, endoscopy.
Costochondritis	Sharp, localised pain in the ribs, worsens with movement or palpation.	Tenderness on palpation of costochondral joints without systemic signs.	Clinical, exclude other causes through X-ray and tests if necessary.
Chest trauma	Sharp pain, dyspnoea, bruising, possible chest deformity.	Recent trauma history with chest pain.	Chest X-ray, CT scan for more detailed injury evaluation.
Pulmonary embolism	Sudden, pleuritic pain, dyspnoea, tachycardia, occasionally haemoptysis.	Clinical suspicion with risk factors such as prolonged immobilisation or recent surgery.	Chest CT angiography, D-dimer, echocardiogram in selected cases.
Pneumothorax	Sudden, sharp pain, dyspnoea, reduced breath sounds, hyperresonance on percussion.	Presence of air in the pleural space with sudden pain and dyspnoea.	Chest X-ray shows pleural line with no underlying lung.
Pneumonia	Pleuritic pain, fever, productive cough, dyspnoea, crackles.	Respiratory symptoms with fever and cough, pleuritic pain.	Chest X-ray with infiltrates, sputum culture.
Anxiety and somatoform disorders	Non-specific chest pain, palpitations, dyspnoea, anxiety, panic.	Anxiety symptoms with chest pain unrelated to exertion.	Psychiatric evaluation, rule out medical causes through ECG and cardiac tests.
Herpes zoster	Burning or stabbing pain with vesicular rash in a specific dermatome.	Pain and rash in a specific area following a nerve.	Clinical, confirmed by the appearance of characteristic vesicular lesions.