Systemic lupus erythematosus [top]

  • Polyarthritis
  • Renal impairment, pleuritic chest pain
  • Rash, photosensitivity, alopecia
  • dsDNA+, ANA+

Musculoskeletal chest pain [top]

  • Central chest pain
  • Pleuritic chest pain
  • Precipitated by chest wall pressure or movement

Pericarditis [top]

  • Central chest pain
  • Sharp character
  • Relieved by leaning forward
  • Saddle shaped ST elevation on ECG

Pneumothorax [top]

  • Pleuritic chest pain
  • Sudden onset
  • Shortness of breath
  • Unequal chest expansion
  • Diminished breath sounds
  • Hyperresonant percussion

Shingles [top]

  • Unilateral chest pain
  • Burning character
  • Dermatomal distribution
  • Pain can precede rash
  • Vesicular rash

Acute coronary syndrome [top]

  • Central chest pain / epigastric pain
  • Crushing
  • Radiation to jaw, left arm or neck
  • Intermittent
  • Duration usually less than 30 minutes

Pneumonia [top]

  • Pleuritic chest pain
  • Shortness of breath
  • Fever
  • Productive cough
  • Haemoptysis
  • Consolidation on CXR

Aortic dissection [top]

  • Central chest pain
  • Sudden onset
  • Tearing character
  • Radiation to back between shoulder blades
  • Unequal peripheral pulses
  • Hypotension
  • Wide mediastinum on chest X ray

Biliary colic [top]

  • Right upper quadrant pain or Chest pain
  • Worse after meal
  • Intermittent 'colicky' pain
  • Precipitated by fatty food
  • Radiation to right scapula

Pulmonary embolism [top]

  • Central chest pain
  • Pleuritic chest pain
  • Shortness of breath
  • Haemoptysis
  • Sudden onset
  • Tachycardia
  • Associated deep vein thrombosis

Gastro-oesophageal reflux [top]

  • Central chest pain or Epigastric pain
  • Burning
  • Recurrent episodes
  • Worse on lying down
  • Acid reflux, occasional haematemesis
  • Relieved by antacids
  • Belching
  • Persistent cough

Myocardial infarction [top]

  • Central chest pain
  • Crushing
  • Radiation to jaw, left arm or neck
  • Continuous
  • Single episode
  • Duration greater than 30 minutes
  • Shortness of breath

Pancreatitis [top]

  • Epigastric pain or Chest pain
  • Radiation to back
  • Nausea and vomiting
  • Excessive alcohol consumption
  • Hypertriglyceridemia
  • Gallstones

Costochondritis [top]

  • Central chest pain or Pleuritic chest pain
  • Pain with pressure over costal cartilage