Chest Pain that Alarms and Intensifies Within Minutes

CLINICAL DIAGNOSTIC MANUAL

Sudden chest pain that intensifies within minutes is a common reason for emergency department visits, due to its association with severe and potentially life-threatening conditions. This type of pain can be highly alarming for the patient, as it is often linked to heart-related issues, but it can also stem from pulmonary, digestive, or musculoskeletal causes. Rapid and accurate evaluation is essential to identify the underlying cause and administer appropriate treatment.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Acute Myocardial Infarction	Crushing chest pain radiating to the left arm, jaw, or back. Sweating, nausea, fatigue, dyspnoea.	Chest pain with cardiovascular risk factors present.	Elevated troponins, ECG changes (elevated ST waves).
Pulmonary Embolism	Sudden, sharp chest pain, dyspnoea, tachycardia, haemoptysis, occasional cyanosis.	Chest pain with dyspnoea, haemoptysis, and risk factors for thromboembolism.	Chest CT with angiography showing pulmonary artery thrombus.
Pneumothorax	Sudden chest pain, dyspnoea, decreased breath sounds on the affected side.	Sudden chest pain in patients with trauma history or spontaneously.	Chest X-ray showing lung collapse.
Pericarditis	Sharp, stabbing chest pain that improves when leaning forward. Fever, infection symptoms.	Acute chest pain relieved by leaning forward.	ECG showing diffuse ST elevation, echocardiogram.
Aortic Dissection	Severe, tearing chest pain radiating to the back. Hypotension, discrepancy in peripheral pulses.	Chest pain radiating to the back, especially in hypertensive patients.	Chest CT or transoesophageal echocardiogram showing aortic dissection.
Unstable Angina	Crushing chest pain with recent onset or worsening of previous angina. Does not improve with rest, may last over 20 minutes.	Chest pain at rest or with minimal exertion in patients with coronary risk factors.	ECG without typical infarction changes, stress test or coronary angiography.
Pleuritis	Chest pain worsened by deep breathing or coughing. Fever and respiratory symptoms.	Pleuritic pain associated with respiratory movements or coughing.	Chest X-ray or ultrasound showing pleural inflammation.
Oesophageal Spasm	Crushing or burning chest pain, may improve with antacids. Occasional dysphagia.	Chest pain unrelated to physical exertion, associated with reflux or dysphagia.	Oesophageal manometry or barium swallow.
Gastroesophageal Reflux Disease	Retrosternal chest pain, burning sensation, acid regurgitation, improves with antacids.	Chest pain unrelated to exertion, accompanied by heartburn.	Proton pump inhibitor trial, upper gastrointestinal endoscopy.
Costochondritis (Tietze’s Syndrome)	Localised pain in the costosternal joints, visible inflammation, tenderness on palpation.	Localised pain, worsened by palpation of the chest wall.	Physical examination, exclusion of other causes, improves with anti-inflammatories.
Panic Attack	Acute chest pain with palpitations, shortness of breath, sweating, dizziness, intense fear.	Chest pain with no apparent physical cause, history of anxiety.	Exclusion of organic causes through cardiac and pulmonary tests.