Patient with chest pain in outpatient practice. A guide for practitioners

Chest pain can be the earliest and, until a certain point, the only manifestation of diseases of the heart, respiratory organs, gastrointestinal tract, neurotic and affective disorders. When assessing chest pain syndrome, the prognostic significance of the disease that may have caused the pain is always taken into account. Chronic intermittent or stable chest pain usually does not require emergency assistance; additional laboratory and instrumental studies are conducted on a planned basis to clarify its genesis. Conversely, acute intense chest pain that is not relieved by nitrates within 15 minutes or more typically requires urgent medical attention and emergency hospitalization of the patient. The doctor must first rule out life-threatening conditions - ACS, aortic dissection, pericarditis, pulmonary embolism. For this, the maximum possible detailing of complaints is necessary, clarifying the nature of the pain, its location, duration of the pain episode, etc., as well as identifying a second symptom. It is evident that from the first minutes of examination, the doctor usually forms a certain diagnostic concept, and to confirm or refute it, a more detailed patient interview is often necessary; the relevant algorithms are presented in the chapters dedicated to specific nosological forms. The book addresses the main issues of differential diagnosis of chest pain and contains algorithms for identifying frequently encountered diseases and syndromes.