Rationale

Chest pain is a very common clinical presentation with a spectrum of underlying causes ranging from benign to life-threatening.

Causal Conditions

(list not exhaustive)

1. Cardiovascular

   1. Ischemic

      • Acute coronary syndromes

      • Stable angina pectoris

   2. Nonischemic

      • Aortic aneurysm

      • Pericarditis

2. Pulmonary or mediastinal

   1. Pulmonary embolus or pulmonary infarction

   2. Pleuritis

   3. Pneumothorax

   4. Malignancy

3. Gastrointestinal

   1. Esophageal spasm or esophagitis

   2. Peptic ulcer disease

   3. Mallory-Weiss syndrome

   4. Biliary disease or pancreatitis

4. Musculoskeletal (e.g., costochondritis)

5. Psychiatric (e.g., anxiety disorders)

Key Objectives

Given a patient with chest pain, the candidate will diagnose the cause and severity, with particular attention to excluding life-threatening diagnoses.

Enabling Objectives

Given a patient with chest pain, the candidate will

1. perform an initial assessment (e.g., ABCs) to determine the urgency of the presentation and need for emergent management;

2. list and interpret critical clinical findings by obtaining a history and performing a physical examination that aids in

   1. differentiating cardiac from noncardiac pain; and

   2. identifying cardiac risk factors;

3. list and interpret critical investigations, including

   1. electrocardiograms (ECGs), chest radiographs, and appropriate laboratory tests; and

   2. identifying, as appropriate, patients for additional investigations (e.g., stress testing, imaging); and

4. construct an effective initial management plan, including

   1. determining urgency of clinical condition;

   2. initiating appropriate therapies in urgent situations (e.g., acute coronary syndrome, aortic dissection, pulmonary embolism, spontaneous pneumothorax);

   3. referring for urgent specialized care as required; and

   4. initiating secondary preventive strategies as indicated.