A diagnostic approach to chest pain based on history and ancillary evaluation

Pain is a major reason patients seek health care. Chest pain, in particular, is a serious concern for patients and clinicians because of its potentially life-threatening implications--misdiagnosis can be fatal. Diagnosis of chest pain is complicated by shared neurologic pathways for thoracic and abdominal visceral organs. The importance of a medical history in the differential diagnosis is discussed. A helpful mnemonic is offered both as an organizational guide for novice practitioners and as a reminder for the seasoned clinician. Included are detailed discussions regarding the neuroanatomy of chest pain, followed by common historical presentations and physical findings related to selected cardiovascular and noncardiovascular etiologies of the condition. A brief discussion of confirmatory laboratory evaluations is included. Several etiologies not discussed in detail are presented in table format.