The differential diagnosis of chest pain

Chest pain is a frequent complaint of patients seeking urgent medical assistance, and accounts for an estimated 2-4 per cent of all A&E visits in the UK (Becker, 2000). Generally, acute chest pain should be considered cardiovascular in origin until proven otherwise and it is common in clinical practice to err on the conservative or ‘safe’ side when evaluating people with chest pain. Individuals with suspected ischaemic chest pain must be evaluated rapidly for several reasons: - Myocardial ischaemia, if prolonged and severe, can cause myocardial infarction (necrosis); - Treatment strategies that achieve myocardial salvage (thrombolytic therapy or primary coronary angioplasty) are available for patients with acute coronary syndromes and these treatments reduce morbidity and mortality;