Evaluating Acute Chest Pain in A Primary Care Setting

Abstract

In the primary care setting, approximately 1% of all visits are for chest pain. Though heart disease is the leading cause of death globally, yet < 2.5% of patients presenting to a primary care office with chest pain will have Acute Coronary Syndrome (ACS). As Acute Coronary Syndrome is a life threating event, the first decision point for most physicians is whether or not the chest pain is caused by coronary ischemia. Clinical diagnosis in most cases is made by the presenting symptoms, physical examination and initial ECG, combined with the patient’s risk of ACS. Physicians should consider applying a validated clinical decision rule to predict heart disease as a cause of chest pain. In situations where chest pain is not thought to be cardiac in origin, other causes must be investigated, some of which may be life-threatening (i.e. pulmonary embolism, aortic dissection or pneumonia). Other common non-cardiac causes of chest pain in the primary care population include Chest wall pain, Reflux esophagitis, Costochondritis, Gastroesophageal reflux disease, anxiety, panic disorder.