Differential Diagnosis of Recurrent Chest Pain

Differential Diagnosis of Recurrent Chest Pain - Flowchart

«Flowchart»

Symptoms and Signs

Symptoms and Signs

Symptoms and Signs
Symptoms and Signs
Localized; sharp/stabbing or persistent/dull pain, reproduced by pressure over the painful area

Localized; sharp/stabbing or persistent/dull pain, reproduced by pressure over the painful area
Localized pain
Sharp pain, may be in radicular distribution; exacerbated by movement of neck, back

Sharp pain, may be in radicular distribution; exacerbated by movement of neck, back
Sharp pain,
Associated with dysphagia or gastric regurgitation; may be worsened by aspirin/alcohol ingestion/certain foods/supine position; often relieved by antacids

Associated with dysphagia or gastric regurgitation; may be worsened by aspirin/alcohol ingestion/certain foods/supine position; often relieved by antacids
Associated with dysphagia
Intolerance of fatty foods; right upper quadrant tenderness also present

Intolerance of fatty foods; right upper quadrant tenderness also present
Intolerance of fatty foods
Precipitated by exertion or emotional arousal; ECG (or Holter monitor) during pain shows ST segment shifts; pain relieved quickly ( < 5 min ) by sublingual TNG

Precipitated by exertion or emotional arousal; ECG (or Holter monitor) during pain shows ST segment shifts; pain relieved quickly ( < 5 min ) by sublingual TNG
Precipitated by exertion or emotional arousal
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Likely Etiology
Costochondral or chest wall pain

Likely Etiology
Costochondral or chest wall pain

Likely Etiology
Likely Etiology
Costochondral or chest wall pain

Likely Etiology
Cervical or thoracic spine disease with nerve root compression

Likely Etiology
Cervical or thoracic spine disease with nerve root compression

Likely Etiology
Likely Etiology
Cervical or thoracic spine disease with nerve root compression

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End

End

End

End

End

Likely Etiology
Esophageal or gastric pain (Chap. 159)

Likely Etiology
Esophageal or gastric pain (Chap. 159)

Likely Etiology
Likely Etiology
Esophageal or gastric pain (Chap. 159)

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End

End

Likely Etiology
Biliary pain (Chap. 162)

Likely Etiology
Biliary pain (Chap. 162)

Likely Etiology
Likely Etiology
Biliary pain (Chap. 162)

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End

End

Likely Etiology
Myocardial ischemia^* (Chap. 130)

Likely Etiology
Myocardial ischemia^* (Chap. 130)

Likely Etiology
Likely Etiology
Myocardial ischemia^* (Chap. 130)
^* ^*
* If myocardial ischemia suspected, also consider aortic valve disease (Chap. 123) and hypertrophic obstructive cardiomyopathy (Chap. 124) if systolic murmur present

* If myocardial ischemia suspected, also consider aortic valve disease (Chap. 123) and hypertrophic obstructive cardiomyopathy (Chap. 124) if systolic murmur present

* If myocardial ischemia suspected, also consider aortic valve disease (Chap. 123) and hypertrophic obstructive cardiomyopathy (Chap. 124) if systolic murmur present