Acute chest pain is a common symptom in emergency medicine. Approaching acute chest pain in emergency departments is a challenge epidemiologically, clinically and organizationally [1]. This symptom requires increased attention from medical professionals, this requiring a primary and careful evaluation for patient, imagining and paraclinical investigations. Attention should also be paid to cardiovascular risk factors (age, high blood pressure, smoking, pre-existing cardiovascular disease, obesity) [2]. In emergency medicine, primary assessment consists of ABCDE evaluation (1. Airway, 2. Breathing, 3. Circulation, 4. Disability, 5. Exposure) [3].

Keywords: Acute chest pain; Emergency medicine; Cardiovascular risck factors; Primary assessment.

Copy right Statement: Content published in the journal follows Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0). © Gabriela-florentina Ț (2023)

Journal: Open Journal of Clinical and Medical Case Reports is an international, open access, peer reviewed Journal mainly focused exclusively on the medical and clinical case reports.

Citation: Gabriela-Florentina Ț, Băgescu-Drugă F, Puticiu M. Acute chest pain... Where?. Open J Clin Med Case Rep. 2023; 2173.

For this mini-review, an intense search was carried out in Google Scholar, PubMed and MDPI, selecting the most recent articles on acute chest pain in emergency department. This mini-reviwe brings in spotlight, the approach of patients with acute chest pain non-traumatic, in emergency departments, especially in low-in come- medium hospitals. Troels Thim and colab., in a research performed in 2012, they are talking about ABCDE evaluation, as useful to all patients; it is also a useful tool in medical and surgical emergencies, this helping in prompt treatment for both before hospital and in hospital [3]. In emergency departments, chest pain should be evaluated immediately and medical professionals must decide whether it is really a medical emergency or not. Traditional diagnostic evaluations involves performing anamnesis, physical examinations and performance of the EKG in 12 derivatives (mandatory) [4]. Most of the time at this presentation in the emergency department acute chest pain is accompanied by other symptoms. Among the causes of chest pain, life – threatening are acute myocardial infarction, pulmonary embolism, pneumothorax, cardiac tamponade, aortic dissection and esophageal perforation [5]. Other causes of chest pain are represented by chest wall pain, pneumonia and gastro-esophageal reflux diseas [5].

In the emergency department according to the study performed by Paul I. Musey and colab., chest pain is the second cause of presentation. Specialists often pay attention to acute chest pain of cardiac cause, trying to exclude such dissection of the aorta, acute coronary syndromes, pulmonary embolism and pneumothorax [6]. Association of neoplastic disease and acute coronary syndromes are causes of death in both high and low in come countries [4-6]. In the research by Paolo Bima and colab 2023, we can note that: patients with neoplatisc pathology have a very high risck of myocardial infarction, when they come in emergency departement with acute chest pain [6,7]. Daniela Barroso and colab., report a rare case of spontaneous pneumomediastin witch began with acute chest pain associated with other symptoms [8]. In emergency department, doctor has the obligation to exclude life – threatening chest pain causes, take into account that sometimes patients may show minimal symptomatology, when they come in emergency; for example, a research performed by Flavio Morello and colab., they draw attention to acute aortic syndromes as rare conditions that may present with non-specific signs and symptoms. In the case of these conditions it is necessary to perform an angiocoronarography with a substance of constrast [9].

The role of qualified staff in emergency departments regarding the patient with acute chest pain is to examine, evaluate and treat the patient. Interdisciplinary consultations (for example, cardiological consultation) are absolutely necessary. It should be remembered that performing on electrocardiogram and cardiac troponin, they can exclude acute coronary syndrome and using ultrasonography helps the doctor of emergency medicin in making a decision on treatment and of course on differential diagnosis [10]. In front of the patient with acute chest pain, the doctor will take into account. The presence of risk factors, the nature of pain, the associated symptomatology and he outcome of the paraclinical investigations or appropriate therapy.

1. Cassin M, Macor F, Cappelletti P, Rubin D, Deganuto L, Tropeano P, Burelli C, Antonini-Canterin F, Badano LP, Solinas L, Zardo F, Hrovatin E, Brieda M, Quadri ND, Nicolosi GL. Management of patients with low-risk chest pain at the time of admission: a prospective study on a non-selected population from the Emergency Department. Ital Heart J. 2002; 3(7): 399-405. PMID: 12189968.
2. Villar F, Pedro-Botet J, Vila R, Lahoz C. Aneurisma aórtico [Aortic aneurysm]. Clin Investig Arterioscler. 2013; 25(5): 224-30. Spanish. doi: 10.1016/j.arteri.2013.10.004. Epub 2013 Nov 12. PMID: 24238836.
3. Thim T, Krarup NH, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med. 2012; 5: 117-21. doi: 10.2147/IJGM.S28478. Epub 2012 Jan 31. PMID: 22319249; PMCID: PMC3273374.
4. Storrow AB, Gibler WB. Chest pain centers: diagnosis of acute coronary syndromes. Ann Emerg Med. 2000; 35(5): 449-61. PMID: 10783407.
5. Fruergaard P, Launbjerg J, Hesse B, Jørgensen F, Petri A, Eiken P, et al. Diagnosticele pacienților internați cu durere toracică acută, dar fără infarct miocardic. Eur Heart J. 1996; 17(7): 1028-34.
6. Musey PI Jr, Bellolio F, Upadhye S, Chang AM, Diercks DB, Gottlieb M, et al. Guidelines for reasonable and appropriate care in the emergency department (GRACE): Recurrent, low-risk chest pain in the emergency department. Acad Emerg Med. 2021; 28(7): 718-744. doi: 10.1111/acem.14296. Epub 2021 Jul 6. PMID: 34228849; PMCID: PMC9115663.
7. Bima P, Lopez-Ayala P, Koechlin L, Boeddinghaus J, Nestelberger T, Okamura B, Muench-Gerber TS, Sanzone A, Skolozubova D, Djurdjevic D, Rubini Gimenez M, Wildi K, Miro O, Martínez-Nadal G, et al. APACE and TRAPID-AMI Investigators. Chest Pain in Cancer Patients: Prevalence of Myocardial Infarction and Performance of High-Sensitivity Cardiac Troponins. JACC CardioOncol. 2023; 5(5): 591-609. doi: 10.1016/j.jaccao.2023.08.001. PMID: 37969646; PMCID: PMC10635894.
8. Barroso D, Rocha D, Abelha Pereira F, Ribeiro R, Pimenta Fernandes J, Pais Monteiro A, et al. Spontaneous Pneumomediastinum: A Rare Cause of Chest Pain. Cureus. 2023; 15(10): 47015. doi: 10.7759/cureus.47015. PMID: 37965408; PMCID: PMC10641820.
9. Morello F, Santoro M, Fargion AT, Grifoni S, Nazerian P. Diagnosis and management of acute aortic syndromes in the emergency department. Intern Emerg Med. 2021; 16(1): 171-181. doi: 10.1007/s11739-020-02354-8. Epub 2020 May 1. PMID: 32358680.
10. Piccioni A, Franza L, Rosa F, Manca F, Pignataro G, Salvatore L, et al. Use of POCUS in Chest Pain and Dyspnea in Emergency Department: What Role Could It Have? Diagnostics 2022; 12: 1620. https://doi.org/10.3390/diagnostics12071620.