I. Initial Approach to the patient with Chest pain
Chest pain is one of the most feared symptoms in primary care. While the priority in any patient who presents with chest pain is to exclude catastrophic or life threatening (cardiac) causes, non-life-threatening etiologies, which may be functionally disabling, are much more common in the primary care setting and require a cost-effective approach to diagnosis. The correct diagnosis is most often derived from a detailed history that is supported by specific physical findings, an electrocardiogram, and/or chest x-ray.

Emergency response to chest pain in the outpatient clinic
Chest pain due to myocardial infarction, pulmonary embolus, aortic dissection, or tension pneumothorax may result in sudden death. Any patient with a recent onset of chest pain, especially when the symptoms are ongoing, who may be potentially unstable based upon history, appearance, or vital signs, should be transported immediately to an emergency department preferably in an ambulance equipped with a defibrillator. Stabilization of such patients should begin in the prehospital setting and includes supplemental oxygen, intravenous access, and placement of a cardiac monitor. A 12-lead electrocardiogram should be obtained if possible. Patients who are thought to be experiencing a myocardial infarction should chew a 325 mg aspirin tablet. Sublingual nitroglycerin should be withheld if the patient has relatively low blood pressure without intravenous access or has recently taken sildenafil (Viagra).

Evaluation of patients with chest pain
The initial goal in the office evaluation of chest pain in stable individuals is to exclude CAD and other potentially life-threatening conditions. The history and physical examination, complemented by selected tests such as an electrocardiogram or chest radiograph, allow the physician to accurately diagnose most causes of chest pain, especially CAD, and to judge which patients likely have a benign etiology. The need for a good history and physical examination is emphasized by the fact that, the accuracy of the clinical examination for determining the presence of CAD is improved only marginally, if at all, by exercise testing. In a study which found that the predictive accuracy for CAD using clinical factors was 84 percent; inclusion of exercise test results increased the predictive accuracy to only 87 percent.

Comment & Contribute Comments should be on the topic and should not be abusive. Comments are normally moderated and are reviewed after they are posted. Post your comments * Your comment can be maximum of 2500 characters I agree to the terms and conditions Your comments are automatically posted once they are submitted. All comments are however constantly reviewed for spam and irrelevant material (such as product or personal advertisements, email addresses, telephone numbers and website address). Such insertions do not conform to our policy and 'Terms of Use' and are either deleted or edited and republished. Please keep your comments brief and relevant.This section may also have questions seeking help. If you have the information you are welcome to respond, but please ensure that the information so provided is genuine and not misleading. If you have a question about health related issues, you can now post it in our Ask An Expert section on our community website Medwonders.com and get answers from our panel of experts. Member Comments ( 8 ) my husband age 33 has a pain in chest from few days if he walk fast (Posted by shaanZee, India Date : 10/27/2010 ) Recently I Lost my mother by heart attached on 21.09.2010, she got chest pain at 10.30pm I call doctor near to me (BAMS) she miss guide me that chest pain due to acidity becouse my mother BP and heart beat is normal at that time and chest pain is in centre part of chest as inform by that doctor. Still for safer side we moved her to cardiologst he take ECG & infor its start of heart attack, he gave her sorbitol & some liquid syrup & asked to move to ICCU. I call abilance from Wackharts but during trasit she got attack and she pass away. The mistake we have done, Loss the time to investigate reason of chest pain Suggession :- Do not wait to invetigate rason for chest pain, just move to the hospital who can investigate & treat the chest pain reason whatever maybe. (Posted by MandarS, India Date : 10/18/2010 ) I have chest pain on the right side and in right arm. Chest Pain started early morning before sun came up. Right arm started around lunch time. Should I go to emergency room? (Posted by nancyk, United States Date : 9/25/2010 ) Dear Sir/Mam Really I find this website very helpful for practitioners & others, I have gained lot of knowledge and found very useful for preparing presentations. I am very much thankful to you. Kind Regards Dr.Prakash (Posted by praku_m2003, United Kingdom Date : 9/2/2010 ) respected sir/mam, last two years i have chest pain mainly in left side, sometime burning feeling on lower left side of chest,aal test are done twice or thrice but no result. i can't described properly as there is no particlar reason behind this but sometime when i argue wid someone or take little stress on my mind i feel more tightness in left side. now from some time i feel pain in left hand alonng with numbness of fingers....sometime stretching sensation in throat and pain in teeh... please help as this creatng nuisance for me nd my family.. my age is 31.. (Posted by aakash, India Date : 5/3/2010 ) View All Comments (8)