Aetiology

A retrospective study in the US, conducted over a 5-year period, of patients aged over 35 years, with a chief complaint of non-traumatic chest pain admitted to hospital from the emergency department, found that chest pain most frequently had a coronary cause.[7] Pulmonary embolism and aortic dissection were rare but important causes.[7][Figure caption and citation for the preceding image starts]: Distribution of final diagnoses in people over 35 years admitted to hospital from one US hospital emergency department with chief complaint of non-traumatic chest pain, over a 5-year period (PE, pulmonary embolism)Created by BMJ; based on data from Kohn MA, Kwan E, Gupta M, et al. Prevalence of acute myocardial infarction and other serious diagnoses in patients presenting to an urban emergency department with chest pain. J Emerg Med. 2005 Nov;29(4):383-90 [Citation ends].com.bmj.content.model.assessment.Caption@1b5c4501

Data from accident and emergency departments in Northern Europe indicate that approximately 10% to 12% of patients presenting with chest pain will receive a diagnosis of unstable angina or myocardial infarction.[8][9]

Reports have indicated that up to 3.5% of patients with a diagnosis of acute coronary syndrome have the diagnosis missed in the emergency department.[10][11][12]

The distribution of aetiologies is different in primary care. Common aetiologies of chest pain in this setting include:[13][14]​​​

  • Musculoskeletal causes

  • Reflux oesophagitis

  • Costochondritis.

An observational study found that most final diagnoses in people presenting with chest pain in primary care are non-life-threatening; however, 8.4% have a life-threatening final diagnosis.[6]

Another study in general practice settings found that most patients had no diagnosis assigned at presentation (72.4%) or within the next 6 months following a first episode of chest pain (no previous record of cardiovascular disease).[15] Those patients who had no diagnosis attributed to their chest pain at 6 months had higher long-term incidence of cardiovascular events compared with patients who had been diagnosed with non-coronary pain.

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