CLINICAL DIAGNOSTIC MANUAL
Severe and Alarming Chest Pain
Cause | Main Characteristics | Symptoms and Signs | Confirmatory Diagnostic Tests |
Acute Coronary Syndrome | Crushing, constrictive, or burning pain | Shortness of breath, sweating, pallor, nausea, vomiting | Electrocardiogram (ECG), cardiac enzymes (troponin) |
Angina Pectoris | Pressing or burning pain, usually triggered by exertion | Relief with rest or nitroglycerin | Electrocardiogram (ECG), stress tests, coronary angiography |
ST-Elevation Myocardial Infarction (STEMI) | Intense, prolonged pain, may be accompanied by sweating and pallor | Symptoms similar to acute coronary syndrome | Electrocardiogram (ECG), cardiac enzymes (troponin), coronary angiography |
Non-ST-Elevation Myocardial Infarction (NSTEMI) | Pressing or burning pain, less prolonged and harder to distinguish from angina | Symptoms similar to acute coronary syndrome | Electrocardiogram (ECG), cardiac enzymes (troponin), coronary angiography |
Oesophagitis and Oesophageal Spasm | Retrosternal pain, often related to food intake | Heartburn, regurgitation, dysphagia | Oesophagoscopy, oesophageal manometry, oesophageal pH monitoring |
Pulmonary Embolism | Pleuritic pain, may be accompanied by haemoptysis | Shortness of breath, tachypnoea, tachycardia | Chest computed tomography (CT), ventilation/perfusion lung scan |
Pneumothorax | Sudden, sharp pain, often unilateral, associated with trauma or spontaneous | Shortness of breath, cyanosis, reduced chest expansion | Chest X-ray, chest computed tomography (CT) |
Thoracic Aortic Dissection | Intense, tearing pain, often radiating to the back | Pulse discrepancy between limbs, neurological deficits | CT angiography (angio-CT), vascular magnetic resonance imaging (MRI) |
Chest Wall Pain (Tietze Syndrome) | Pain in the costal cartilage, often localized | Local swelling, tenderness on palpation | Clinical diagnosis, exclusion of other causes |
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