Chest Pain Differential

Chest pain can originate from cardiac ischemia (demand exceeding supply), pleural irritation, musculoskeletal strain, esophageal spasm, or anxiety. Cardiac pain is mediated by visceral afferent nerve fibers that also innervate the arm and jaw, explaining referred pain patterns.

Risk factors: - Coronary artery disease risk factors - GERD or esophageal disorders - Musculoskeletal injury or strain - Anxiety/panic disorder - Pulmonary conditions (PE, pneumothorax) - Aortic dissection risk factors - Pericarditis

Diagnostics: - Expect 12-lead ECG within 10 minutes of arrival - Expect serial troponin levels - Expect chest X-ray - Monitor continuous telemetry - Expect D-dimer if PE suspected - Monitor oxygen saturation