[Acute chest pain]

Acute chest pain is very frequent in medicine and caused by several cardiac disorders or disorders of the great vessels. In addition, chest pain is well known as "noncardiac chest pain" or due to functional abnormalities. For prognosis and long-term follow-up, acute coronary syndromes (ACS) and ascending aortic dissections are important disorders.

The ACS represents a heterogeneous group of patients along a continuum of risk from unstable angina (UA) to non-ST segment elevation (NSTEMI) to ST segment elevation myocardial infarction (STEMI). In patients with NSTEMI/UA, beta-blockers, nitrates and calcium antagonists will improve chest pain, and invasive management of ACS is indicated in < 48 h, if risk factors are present. In patients without risk factors, stress studies and conservative treatment are mandatory. In patients with STEMI, nitrates, aspirin, heparin, and beta-blockers are required, and therapy of first choice is reperfusion with percutaneous coronary intervention (PCI). Acute ascending aortic dissection has a poor prognosis with mortality rates of 60% within 24 h, 75% within 1 week, and 90% within 3 months. Immediate surgical management of acute type A aortic dissection is necessary, whereas conservative treatment is preferred in acute type B aortic dissection. Both types require adequate therapy of hypertension. Acute pericarditis is caused by several factors; cardiac tamponade with pericarditis or pericardial effusion is associated with circulatory compromise and may be life-threatening. Acute pericarditis generally takes a benign course after empirical treatment with nonsteroidal or steroidal anti-inflammatory drugs. Immediate percutaneous pericardiocentesis is required, if cardiac tamponade is present.

In many patients, chest pain is caused by functional abnormalities with impaired quality of life. In these, exclusion of an underlying organic heart disease and patient information on it are essential.