Q&A: Diagnosis of Chest Pain

Patients who present with chest pain are a diagnostic challenge given the wide array of possible etiologies, including a potentially life-threatening condition. Studies have estimated that approximately one-third to one-half of these patients have musculoskeletal chest pain, 10 to 20 percent have gastrointestinal causes, 10 percent have stable angina, 5 percent have respiratory conditions, and approximately 2 to 4 percent have acute myocardial ischemia (including myocardial infarction).

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This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find more useful one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.

In this article:
Life-threatening chest conditions
MCQ: clinical scenario
MCQ: answer
MCQ: explanation

Life-threatening chest conditions

Causes of chest pain that pose an immediate threat to life are listed below:

• Acute coronary syndrome
• Acute aortic dissection
• Pulmonary embolism
• Tension pneumothorax
• Pericardial tamponade
• Mediastinitis (eg, esophageal rupture)

MCQ: clinical scenario

A 14-year-old boy scout complains of exercise-induced sharp chest pain at the left lower sternal border that diminishes with resting and does not awaken him. He has never had anything like this before. Palpation along the sternal edge replicates the symptoms.

The most likely diagnosis is:

a) mitral insufficiency
b) aortic stenosis
c) pericarditis
d) tricuspid incompetence
e) costochondritic pain
f) hiatus hernia
g) perciardial tamponade
h) reflux esophagitis
i) aortic insufficiency
j) pleuritis

MCQ: answer

The correct answer is E

MCQ: explanation

To diagnose costochondritic pain one may palpate the fingers up the ribs alongside the sternum or compress or lift the rib cage. This would elicit chest wall pain. Chest wall problems and GI causes account for over 70% of the chest pain primary care physicians see.

Reference(s)
1). UpToDate: Outpatient evaluation of the adult with chest pain. Available online: https://www.uptodate.com/contents/outpatient-evaluation-of-the-adult-with-chest-pain