Differential Diagnosis of Recurrent Chest Pain - Flowchart
Differential Diagnosis of Recurrent Chest Pain - Flowchart
«Flowchart»

Start

Start

Start

Likely Etiology

Likely Etiology

Likely Etiology

Likely Etiology

End

End

End

*  If myocardial ischemia suspected, also consider aortic valve disease (Chap. 116) and hypertrophic obstructive cardiomyopathy (Chap. 117) if systolic murmur present.

*  If myocardial ischemia suspected, also consider aortic valve disease (Chap. 116) and hypertrophic obstructive cardiomyopathy (Chap. 117) if systolic murmur present.

*  If myocardial ischemia suspected, also consider aortic valve disease (Chap. 116) and hypertrophic obstructive cardiomyopathy (Chap. 117) if systolic murmur present.

*

TNG, trinitroglycerin.

TNG, trinitroglycerin.

TNG, trinitroglycerin.

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; sharp/stabbing or persistent/dull 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 or gastric regurgitation

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 during pain shows ST segment shifts; pain relieved quickly (<5 min) by sublingual TNG

Precipitated by exertion or emotional arousal; ECG during pain shows ST segment shifts; pain relieved quickly (<5 min) by sublingual TNG

Precipitated by exertion or emotional arousal

Biliary pain (Chap. 154)

Biliary pain (Chap. 154)

Biliary pain (Chap. 154)

Costochondral or chest wall pain

Costochondral or chest wall pain

Costochondral or chest wall pain

Esophageal or gastric pain (Chap. 150)

Esophageal or gastric pain (Chap. 150)

Esophageal or gastric pain (Chap. 150)

Cervical or thoracic spine disease with nerve root compression

Cervical or thoracic spine disease with nerve root compression

Cervical or thoracic spine disease with nerve root compression

Myocardial ischemia*  (Chap. 123)

Myocardial ischemia*  (Chap. 123)

Myocardial ischemia*  (Chap. 123)

* *