Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Chest pain

Key sources
The following summarized guidelines for the evaluation and management of chest pain are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024; 2021; 2017) and the Society of Cardiovascular Computed Tomography (SCCT/SCMR/AHA/SAEM/ASE/ACC/ACCP 2021).
1
2
3
4

Guidelines

1.Diagnostic investigations

History and physical examination: elicit a focused history including characteristics and duration of symptoms relative to presentation as well as associated features and assess cardiovascular risk factors in patients presenting with chest pain.
B
Show 7 more
Create free account

More topics in this section

  • ECG

  • Troponin levels

  • Transthoracic echocardiography

  • Chest radiography

  • Evaluation for ACS (general principles)

  • Evaluation for ACS (low risk)

  • Evaluation for ACS (intermediate risk)

  • Evaluation for ACS (high risk)

  • Evaluation for non-ischemic cardiac causes (acute aortic syndrome)

  • Evaluation for non-ischemic cardiac causes (myopericarditis)

  • Evaluation for non-ischemic cardiac causes (VHD)

  • Evaluation for non-ischemic cardiac causes (PE)

  • Evaluation for non-cardiac causes (general principles)

  • Evaluation for non-cardiac causes (pleuritic chest pain)

  • Evaluation for non-cardiac causes (costochondritis)

  • Evaluation of stable chest pain (low risk)

  • Evaluation of stable chest pain (intermediate-high risk)

  • Evaluation of stable chest pain (known obstructive CAD)

  • Evaluation of stable chest pain (known nonobstructive CAD)

  • Evaluation of stable chest pain (INOCA)

2.Specific circumstances

Post-coronary artery bypass graft patients, acute chest pain
Consider obtaining stress imaging to evaluate for myocardial ischemia or coronary CTA for graft stenosis or occlusion in patients with a history of CABG surgery presenting with acute chest pain not having ACS.
B
Consider obtaining invasive coronary angiography in patients with a history of CABG surgery presenting with acute chest pain not having ACS or having an indeterminate/nondiagnostic stress test.
B

More topics in this section

  • Post-CABG patients (stable chest pain)

3.Follow-up and surveillance

Transfer to emergency department: transport patients with clinical evidence of ACS or other life-threatening causes of acute chest pain seen in the office setting to the emergency department urgently, ideally by emergency medical services.
B
Show 4 more

4.Quality improvement

Cultural competency training
Implement cultural competency training to help achieve the best outcomes in patients of diverse racial and ethnic backgrounds presenting with chest pain.
B
Address language barriers with the use of formal translation services among patients of diverse race and ethnicity presenting with chest pain, if English is not their primary language.
B