Acute Chest Pain in Adults: Outpatient Evaluation

Approximately 1% of all ambulatory visits in primary care settings are for chest pain. Cardiac disease is the leading cause of death in the United States, yet only 2% to 4% of patients presenting to a primary care office with chest pain will have unstable angina or an acute myocardial infarction. The most common causes of chest pain in the primary care population are chest wall pain (20% to 50%), reflux esophagitis (10% to 20%), and costochondritis (13%). Other potential factors include pulmonary etiologies (pneumonia, pulmonary embolism [PE]), psychological etiologies (panic disorder), and nonischemic cardiovascular disorders (congestive heart failure, thoracic aortic dissection). No definitive diagnosis may be found in as many as 15% of patients. Differentiating ischemic from nonischemic causes is often challenging because patients with ischemic chest pain may appear well. As such, the initial diagnostic approach should always consider a cardiac etiology for the chest pain unless other causes are apparent.

(Am Fam Physician. 2020; 102(12): 721-727. Copyright © 2020 American Academy of Family Physicians.)