The approach to non-traumatic chest pain requires the early recognition and exclusion of potential life threats, then further consideration of other causes.
Potentially life-threatening causes of chest pain
- Acute coronary syndromes (STE-ACS and NSTE-ACS)
- Aortic dissection
- Myocarditis (most common cause of sudden death in the young)
- Cardiac Tamponade
- Pulmonary embolism
- Cardiac valve disease e.g. aortic stenosis, mitral stenosis, mitral valve prolapse
- Stress Cardiomyopathies e.g. Takotsubo
- Tension pneumothorax
- Acute chest syndrome (in sickle cell disease)
- Boerhaave syndrome (perforated oesophagus)
Common non-life-threatening causes of chest pain
- Biliary colic
- Gastroesophageal reflux
- Peptic ulcer disease
Chest wall syndromes
- Musculoskeletal pain
- Thoracic radiculopathy
- Bornholm disease (Acute, transient viral myositis associated with Coxsackie B)
- Tietze syndrome (Idiopathic benign inflammation of one or more of the costal cartilages)
- Texidor twinge (precordial catch syndrome)
- Mondor disease
- Da Costa syndrome (Symptom-complex characterized by palpitation, dyspnea, precordial pain, fatigue, exaggerated emotional responses with increased cardiac awareness)
- rib fractures
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.