Chest Pain

Abstract

Approximately 1% of primary care office visits are for chest pain, and 1.5% of these patients will have unstable angina or an acute myocardial infarction. The initial goal in patients presenting with chest pain is to determine if the patient needs to be referred for further testing to evaluate for acute coronary syndrome or myocardial infarction. The physician should consider patient characteristics and risk factors to help determine initial risk (Sekhri et al. Heart 93(4):458–463, 2007).

Algorithmic approaches to the diagnosis and workup of the patient presenting with chest pain in the office setting have not been specifically studied. Differentiating ischemic from nonischemic causes often is difficult, and patients with chest pain with an ischemic etiology often appear well. Therefore, the initial diagnostic approach should always consider a cardiac etiology for the chest pain, unless other causes are apparent.