Chest pain

Nearly the most common complaint when presenting to an emergency room. The differential diagnosis (possible causes) list is long and varied. Pretty much anything from the jaw to the belly button can cause chest pain. There are volumes of literature on how to work up, diagnose and treat chest pain. The general approach is to rule-out things which are quickly fatal if missed. Often this becomes telling patients what they don’t have: No heart attack, pulmonary embolism (lung blood clot), collapsed lung, ruptured major blood vessel. Even if you’re still having chest pain once all the major items are excluded that’s enough for us to say it’s not dangerous and you can go home.

Some of the common tests we do to investigate these things are: chest imaging with a chest x-ray or CT scan, EKG of the heart’s electricity, bloodwork to check the “heart markers” (troponins), ultrasound of the abdomen. Pending on these results further testing can be done if indicated. Depending on the history, physical, and these test results the ER doctor determines whether to discharge a patient home or admit them to the hospital. If admission is indicated, they call the hospitalist to admit the patient.

Part of the challenge (and fun) of medicine is the exact same condition can present a myriad of ways in different patients and identical symptoms in multiple patients can be completely different diagnoses.