• Women's Services

    Many of our women's health services, including classes, women's imaging, lactation services and the Family Birth Center, are conveniently grouped in the Women's Center, a four-story building located on the SAMC campus. Read More
  • Southeast Cancer Center

    A Commission on Cancer approved program, Southeast Cancer Center provides compassionate care for more than 800 newly diagnosed patients each year and cancer patients with ongoing treatment needs. Read More
  • Neurosurgery

    The NeuroSpine Center is a unique specialty clinic with highly trained physicians treating brain, spine and peripheral nerve conditions. A normal, active lifestyle can be regained with modern neurosurgery methods. Read More
  • Pain Management

    The Southeast Pain Management Center is a state-of-the-art clinic staffed by physicians board certified in Anesthesiology and Pain Management. We partner with other physicians with an emphasis on wellness. Read More
  • Behavioral Health Services

    SAMC offers a comprehensive array of mental health services, supported by board certified, highly-qualified, private practice, and staff psychiatrists as well as nurses, social workers, psychologists and other clinical specialists. Read More
  • Heart & Vascular

    SAMC has the strongest cardiac care program in the region, ranked in the top 10 percent nationally in patient safety in heart attack treatment and major cardiac, interventional coronary and vascular care. Read More
  • Orthopedic Services

    Our orthopedic program has a strong reputation of providing specialized orthopedic and rehabilitation services for patients of all ages. We offer a specialized program for older patients who suffer fractures from falls. Read More
  • Wound Care Center

    The Wound Care Center offers state-of-the-art outpatient clinical wound care and hyperbaric medicine. We specialize in advanced wound care using a variety of treatments, therapies and support services. Read More
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News

Dec 05 2012

The differential diagnosis of patients presenting with chest pain is extensive, ranging from benign musculoskeletal etiologies to life-threatening cardiac disease. Many of the diseases that cause chest pain are reviewed in detail elsewhere. This topic will discuss the differential diagnosis of chest pain in an approximate order of prevalence seen in primary care practice. Within each subsection, diseases that may pose an immediate life-threat are discussed first, followed by the more common etiologies, and then by other causes of chest pain. Details about the office evaluation of the patient with chest pain are found separately.

CHEST WALL PAIN

Chest wall causes of pain are among the most common etiologies of chest pain seen by primary care clinicians, accounting for 36 percent of episodes in one report (table 1A-B) [1]. Chest wall tenderness may present concomitantly with myocardial ischemia; the latter should be considered first in any patient at risk by age, history, or associated symptoms [1]. Causes of true chest wall pain may be musculoskeletal or related to the skin and sensory nerves.

Musculoskeletal pain — Demographic features, characteristics of the chest pain, and associated symptoms may favor the diagnosis of musculoskeletal chest pain or suggest other causes of chest discomfort (table 2). As an example, the patient may describe a history of repetitive or unaccustomed activity involving the upper trunk or arms. Certain characteristics of the chest pain or associated symptoms may suggest a nonmusculoskeletal origin. (See "Clinical evaluation of musculoskeletal chest pain".)

Musculoskeletal chest pain is often insidious and persistent, lasting for hours to weeks. It is frequently sharp and localized to a specific area (such as the xiphoid, lower rib tips, or midsternum), but may be diffuse and poorly localized. The pain may be positional or exacerbated by deep breathing, turning, or arm movement; the first two, however, are also noted in a variety of visceral processes, particularly those involving the pleura and pericardium.

The proportion of patients with chest pain having a musculoskeletal source varies with the clinical setting. It is more common in ambulatory patients presenting to their primary care clinician than presenting to an emergency department (table 3). It also occurs more frequently among women than men. One study examined the incidence of musculoskeletal chest pain in 122 consecutive patients presenting to an emergency department with chest pain [2]. Of 36 patients diagnosed with costochondritis, 69 percent were women. By comparison, women represented only 31 percent of the presenting patients who did not have a subsequent diagnosis of costochondritis.