Chest Pain Differential

Chest pain is a symptom, not a diagnosis. The first clinical question is not “What benign condition explains this?” but “Which immediately dangerous process could be causing this, and what cannot wait?” Acute coronary syndrome (ACS), acute aortic syndrome, pulmonary embolism (PE), tension pneumothorax, esophageal rupture, and pericarditis complicated by cardiac tamponade can all deteriorate rapidly. Musculoskeletal pain, gastroesophageal disease, and anxiety are common, but they become reasonable conclusions only after the dangerous alternatives have been assessed. Mechanism helps the nurse recognize why these conditions look different. ACS reduces myocardial oxygen supply through acute plaque disruption, thrombosis, or a supply-demand mismatch. Aortic dissection allows blood to enter the aortic wall, potentially obstructing branch vessels or rupturing into the pericardium. PE blocks pulmonary blood flow and may acutely strain the right ventricle. Tension pneumothorax raises intrathoracic pressure until venous return and cardiac output fall. Tamponade compresses the heart from outside, preventing adequate filling. Use “cardiac,” “possible cardiac,” or “noncardiac” when describing the working impression. Avoid “atypical chest pain.” That label can falsely reassure clinicians when a patient’s presentation differs from the...