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Chest pain

Causes
Clinical features
Investigations
Therapy
Prognosis
Clinical features

Ask about the pain: specifically any radiation a particularly to the right arm or shoulder b

Why?

Chest pain that radiates to the arms makes a myocardial infarction more likely

Patient Target Disorder and
Reference Standard		 Diagnostic Test LR+
(95% CI) 		Post-test Probability LR-
(95% CI) 		Post-test Probability
anterior chest pain b
(pre-test probability: 12%) 		myocardial infarction
(cardiac enzymes, ECG) 		chest pain radiation to right shoulder 2.9
(1.4 to 6.0) 		29% 0.90
(0.81 to 1.0) 		11%
attending emergency department with chest pain b
(pre-test probability: 20%) 		myocardial infarction
(ECG and cardiac enzyme changes) 		chest pain radiation to left arm 2.3
(1.7 to 3.1) 		37%
 
    chest pain radiation to both left and right arm 7.1
(3.6 to 14) 		64%
 
 

 

Expiry date: June 2003
Levels of Evidence used in grading these guides

Author   CM   Ball
Reviewer   S   Straus
CAT Writers   CJ   Wotton , CM   Ball , N   Shenker , RS   Phillips