CHEST PAIN: Cardiac/Non-Cardiac

Chest Pain Cardiac (Ischemic)​ ​ Characteristics:​ Retrosternal pain​ Exertional​ Relieved by rest or nitroglycerin​ Older Age = ↑ risk ​ +/- History of cardiovascular disease ​ Presence of other cardiac risk factors (male sex, HTN, diabetes, smoking, dyslipidemia, family history1) ​Non-Cardiac​ ​ Characteristics:​ Location of pain can vary​ Non-exertional​ Not relieved by rest​ Age < 40 (*exceptions)​ Absence of cardiac risk factors (*exceptions)​ Acute Coronary Syndrome (ACS)​ New/worsening anginal symptoms​ Stable Angina Non-Life-Threatening Causes​ Life-Threatening Causes​ Known CAD with predictable pain pattern​ GERD​ Costochondritis​ Anxiety/Panic​ Pneumonia Pulmonary Embolism​ Cardiac Arrythmia*​ Aortic Dissection*​ STEMI NSTEMI Unstable Angina​ ECG: ST elevation or new LBBB​ Troponin ↑​ ECG: ST depression, T-wave inversion or normal​ Troponin ↑​ ECG: ST depression, T-wave inversion or normal​ Troponin normal​ ECG: ST depression, T-wave inversion or normal​ Troponin normal​