Causes

• myocardial infarction
• angina
• pulmonary embolism
• chest infection
• musculoskeletal pain
• pericarditis

• aortic dissection
• oesophageal spasm

• One in six patients with anterior or left-sided chest pain have a myocardial infarction (14% to 20%) ^a
• The risk is higher in elderly patients (20%: 95% CI: 19% to 22%) ^a and patients with a typical history ^a
• One in four patients anterior or left-sided chest pain have unstable angina (24%: 95% CI: 21% to 27%) ^a - the risk is higher in elderly patients (44%: 95% CI: 42% to 45%) ^a

Myocardial infarction, angina and pulmonary embolism are common causes of chest pain

Chest pain in emergency departments a c	% (95% CI)
myocardial infarction	14% to 20%
unstable angina	24% (21% to 27%)
stable angina	9.0% (5.6% to 12%)
pulmonary embolism	5.8% (3.0% to 8.5%)
other pulmonary disease	5.8% (3.0% to 8.5%)
chest wall pain	5.4% (2.7% to 8.1%)
pericarditis	5.0% (2.5% to 7.6%)
psychogenic	2.9% (0.9% to 4.8%)
other heart disease	1.1% (0.0% to 2.3%)
other disease	1.1% (0.0% to 2.3%)
unknown	11% (7.5% to 15%)

• Only 40% of cases or aortic dissection are diagnosed following history, physical, ECG and CXR. (14% mistaken for ischaemic heart disease, 14% for other aortic disease, 7% heart failure) ^c