The Chest pain dilemma

Patients that present with chest pain

Patients that present with chest pain or discomfort can create a real dilemma for the clinician. I have worked in A&E for many years now and have seen young people that presented with chest pains that ended up being heart attacks, blood clots on the lungs and aortic aneurysms.

So how do I decide where to start?

The history take is the most essential part of the chest pain dilemma.

It is important to use a tool such as S.O.C.R.A.T.E.S. which will enable you to make a more thorough and objective history take.

Site:

Where is the pain? This is important because we know cardiac pain is non-specific or ‘visceral pain’, which usually radiates across the whole chest or into the throat or back. If the patient is able to point at the pain with one finger it is very unlikely to be cardiac in nature. If they use their whole hand this is more significant.

Onset:

The time of onset of pain is essential to establish because it will enable us to risk assess the patient. If the pain started years ago it is less likely to be serious but still warrants further investigation by their GP. If it is acute then this will effect our decision making and how reliable the blood tests can be. For example a…