Chest pain in patients is a common encounter in both the outpatient clinic and the emergency department. Chest pain can result in a wide range of etiologies from common minor illnesses to life-threatening illnesses. In assessing the patient in the initial step, it is of paramount importance that the evaluation consists of the specific patient’s medical history, a physical examination, and the performance of an electrocardiogram (ECG). These steps will be important towards the determination of the acuity and severity of the patient’s clinical presentation and thus guide the proper identification and selection of subsequent additional diagnostic and the corresponding therapeutic modalities. Of the three factors identified in the initial patient assessment, their history remains of paramount importance and the cornerstone of the clinical assessment. However, as Ayerbe et al. (2016) indicate, while the three initial steps are critical to identifying subsequent additional diagnostics, predictive tools are helping clinicians in decision-making at an early age. Before the consideration of any possibilities, the history, a physical examination, and the performance of an ECG will be crucial in an initial diagnosis process.
In diagnosing chest pain differential diagnoses will include chest wall pain and gastroesophageal reflux disease. According to John & Oza (2013), for chest wall pain the clinical findings will include localized muscle tension, absence of cough, pain reproducible by palpation, and stinging pain. A combination of two of the above findings may implicate chest wall pain. The treatment and intervention of treatment of chest wall pain are dependent on musculoskeletal problems, rheumatic conditions, and lung infection and may include cardiac catheterization, bypass surgery, or antibiotics. Gastroesophageal reflux disease clinical findings will include bitter or sour taste, burning retrosternal pain, and acid regurgitation (John & Oza, 2013). Treatment and medication will include antacids to reduce acid production.
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References
Ayerbe, L., González, E., Gallo, V., Coleman, C. L., Wragg, A., & Robson, J. (2016). Clinical assessment of patients with chest pain; a systematic review of predictive tools. BMC cardiovascular disorders , 16 (1), 18.
John, M., & Oza, R. S. (2013). Outpatient diagnosis of acute chest pain in adults. American family physician , 87 (3).
