1- Chest wall pain:-Musculoskeletal pain Isolated musculoskeletal chest pain syndromes Rheumatic diseases Costochondritis Degenerative joint disease of cervical or thoracic spine -Skin (cellulitis) -Sensory nerves

2- Pulmonary causes:Pulmonary vasculature: Acute pulmonary thromboembolism Pulmonary hypertension and corpulmonale Lung parenchyma: Pneumonia Cancer Sarcoidosis Pleura and pleural space Pneumothorax Pleuritis/serositis Pleural effusion

3- Cardiac causes:Coronary heart disease (angina pectoris and myocardial infarction) Aortic dissection Valvular heart disease (aortic stenosis) Pericarditis Myocarditis Stress-induced cardiomyopathy

4- Gastrointestinal causes:Gastroesophageal reflux disease Cholecystitis pancreatitis Abnormal motility patterns and achalasia Esophageal rupture Mediastinitis Medication-induced esophagitis

5- Psychogenic/Psychosomatic Causes Of Chest Pain

6- Pain referred to the chest

1-Myocardial infarct 2-Unstable angina 3-Thoracic aortic dissection 4-Pulmonary embolus 5-Tension pneumothorax 6-Oesophageal rupture

Initial approach1-Assume the worst! 2-100% Oxygen 3-IV access 4-Monitoring 5-ECG quickly 6-Done in tandem with history taking

1- Pain history:1-Nature 2-Site 3-Severity 4-Radiation 5-Onset 6-Exciting/relieving factors 7-Associated features 8-Duration 9-Previous similar pains

2- Examination:1- General Examination (sweaty, pale, cyanosed, anaemic, pulse and BP) 2- Cardiovascular examination ( heart sounds and murmurs ) 3- Respiratory examination ( wheezes and crackles)

3- Investigations:1- Lead ECG is the most important 2- Cardiac enzymes 3- X-ray chest