Approach to a Patient with Chest Pain: Life-Threatening Causes, Assessment, ECG Evolution and Investigations

An emergency lecture on chest pain as one of the most common complaints presenting to emergency departments worldwide. It lists the life-threatening causes to recognise - acute coronary syndrome, acute aortic dissection with its tear between intima and media, pulmonary embolism, tension pneumothorax, pericardial tamponade and pericarditis, and mediastinitis - and takes the history and the physical findings that separate a cardiac source from chest-wall tenderness or an epigastric gastrointestinal one. The investigation section covers the twelve-lead ECG within ten minutes as recommended, its evolution in STEMI and its limited value in pulmonary embolism, the cardiac biomarkers, the chest radiograph and the imaging.