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Box 7.1

Causes of Acute Chest Pain

CommonLess common or rare
CoronaryAcute coronary syndromeAngina due to tachyarrhythmia
Other cardiovascular

Pulmonary embolism

Pericarditis

Stress cardiomyopathy

Myocarditis/myopericarditis

Aortic dissection and other aortic syndromes

Oesophageal

Gastro-oesophageal reflux

Oesophageal motility disorder

Oesophageal candidiasis (chest pain on swallowing)

Other infective and inflammatory causes of oesophagitis

Oesophageal rupture

Pulmonary

Pneumonia

Other lower respiratory tract infections

Pleurisy

Pneumothorax

Pneumomediastinum

Vaso-occlusive sickle crisis

Chest wall

Benign chest wall pain

Rib contusion and fracture

Intercostal muscle strain

Costochondritis

Vertebral crush fracture

Chest wall involvement by cancer

Referred pain from thoracic spine

Intra-abdominal*

Pancreatitis

Peptic ulcer

Biliary tract disease

SkinHerpes zoster

*Usually upper abdominal rather than chest pain.