Chest pain is a commonly encountered complaint in the outpatient setting. Determining its cause is of utmost importance. While the majority of chest pain is caused by musculoskeletal and gastrointestinal etiologies, ruling out cardiac ischemia (poor blood flow to the heart) is of major concern. Other life threatening causes including but not limited to pulmonary embolism, aortic dissection, and pneumonia must be considered but are beyond the scope of this article.
When trying to rule out cardiac ischemia many questions must be answered. These include the character of the pain, duration, radiation, and factors that make the pain worse or better. Also of importance are associated symptoms such as sweating, nausea, shortness of breath, and dizziness. Physical findings on exam include “wet lungs”, abnormal heart rates, blood pressure abnormalities, and abnormal heart sounds. Ancillary testing such as EKG and lab tests can further solidify the diagnosis.
Finally, risk factors can assist in the diagnosis. Such factors that increase cardiac risk include family history, smoking, hypertension, diabetes, sedentary lifestyle, and high cholesterol. As you can guess, modifying those risk factors over which you have control can significantly reduce your risk of heart disease.