Approach to Chest Pain

Chest pain is one of the most common presenting complaints. There are many causes of chest pain ranging from cardiac to gastrointestinal problems. However, there are a few critical or life-threatening diagnoses causing chest pain that must not be forgotten.

Can you list at least 6 potentially life-threatening causes of chest pain?

  1. Acute coronary syndrome (ACS)
  2. Aortic dissection
  3. Pulmonary embolism (PE)
  4. Pneumothorax
  5. Pericarditis with tamponade
  6. Esophageal rupture

Why does the pain in chest pain radiate to other locations such as the arms? “Referred Pain”

Somatic afferent fibers synapse on the same dorsla root ganglia as the thoracic viscera, and chest pain can be mistakenly perceived as originating from the arms, shoulders, or neck.

Afferent nerve fibers from multiple organs enter the thoracic dorsal ganglia – these include the heart, lungs, great vessels, and esophagus. Therefore, pain from all these organs results in the same difficult to localize chest pain.

Also, the dorsal segments overlap 3 segments above and below a level, so a disease in the thoracic region can result in pain from the jaw all the way to the epigastrium.