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Chest pain is a common complaint and encompasses a broad differential diagnosis that includes several life-threatening causes. A workup must focus on ruling out serious pathology before a clinician considers more benign causes.
Chest pain is a common complaint and encompasses a broad differential diagnosis that includes several life-threatening causes. A workup must focus on ruling out serious pathology before a clinician considers more benign causes. Common descriptors of visceral pain are dull, deep, pressure and squeezing. Visceral pain also refers to other locations as a result of the nerves coursing through somatic nerve fibers as they reach the spinal cord. Ischemic heart pain, for example, may refer to the left or right shoulder, jaw or left arm.
CHEST PAIN DIAGNOSIS AND TREATMENT
In the emergency department chest pain is the second most common complaint comprising approximately 5% of all emergency department visits. In evaluating for chest pain, the provider should always consider life-threatening causes of chest pain. These are listed below with approximate percent occurrence in patients presenting to the emergency department with chest pain based on a study by Fruerfaard et al.
- Acute coronary syndrome (ACS), 31%
- Pulmonary embolism (PE), 2%
- Pneumothorax (PTX), unreported
- Pericardial tamponade, unreported (pericarditis 4%)
- Aortic dissection, 1%
- Esophageal perforation, unreported
Other common causes of chest pain with approximate percent occurrence in patients presenting to the emergency department with chest pain include:
- Gastrointestinal reflux disease, 30%
- Musculoskeletal causes, 28%
- Pneumonia/pleuritis, 2%
- Herpes zoster 0.5%
- Pericarditis, unreported
ICD-10 CODES FOR CHEST PAIN
| Codes | Code Description |
|---|---|
| R07.1 | Chest pain on breathing |
| R07.89 | Other chest pain |
| R07.2 | Precordial pain |
| R07.81 | Pleurodynia |
| R07.82 | Intercostal pain |
| R07.9 | Chest pain, unspecified |
| I20.0 | Unstable angina |
| I20.1 | Angina pectoris with documented spasm |
| I20.8 | Other forms of angina pectoris |
| I20.9 | Angina pectoris, unspecified |
| G89.12 | Acute post-thoracotomy pain |
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