Approach to Chest pain in Emergency Ward

Emergency Medicine Specialist, Tabriz University of Medical Sciences Approximately 6 million patients visit the emergency department each year with complaints of chest pain in the United States. Chest pain is a symptom caused by several life-threatening as well as non- life- threatening disease and has a broad differential diagnosis. Acute coronary syndrome, aortic dissection, pulmonary embolism, pneumothorax, pericarditis with tamponade, and esophageal rupture are potentially catastrophic cause of chest pain.Because of the indistinct nature of visceral pain, the differential diagnosis of chest pain is broad and includes many of the most critical diagnoses in medicine and many nonemergent conditions. In clinical evaluation of the patient, the initial questions are Should I intervene now and What are the life-threatening possibilities in this patient The history and physical examination are key to diagnosis. The patient is asked to describe the character of the pain or discomfort, patient s activity at the onset of pain, severity of pain, location of the discomfort, radiation of pain, duration of pain, aggravating or alleviating factors, associated symptoms, prior pain and the diagnosis of that episode and risk factors.ECG and the chest radiograph are the two most commonly performed studies and an ECG should be performed within 10 minutes of arrival in all patients with chest pain or optional angina equivalent in whom myocardial ischemia is a possibility. Patients with critical diagnoses generally are admitted to the intensive care unit. Patients with emergent diagnoses typically are admitted to the hospital. Patients with nonemergent diagnoses are most frequently treated as outpatients.