Chest pain medical therapy

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Chest pain Microchapters


Patient Information


Historical Perspective




Differentiating Chest pain from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis

Chest Pain in Pregnancy


Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings



Echocardiography and Ultrasound

CT scan


Other Imaging Findings

Other Diagnostic Studies


Medical Therapy



Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Chest pain medical therapy On the Web

Most recent articles

cited articles

Review articles

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Powerpoint slides


Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chest pain medical therapy

CDC on Chest pain medical therapy

Chest pain medical therapy in the news

Blogs on Chest pain medical therapy

to Hospitals Treating Chest pain medical therapy

Risk calculators and risk factors for Chest pain medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]


A correct diagnosis of the underlying cause of the chest pain is necessrary prior to deciding on an appropriate treatment strategy. The most dangerous causes should be evaluated first. If myocardial infarction or ischemia is suspected, the immediate pharmacotherapies including morphine, oxygen, nitrate, aspirin, ACE inhibitors.

Medical Therapy

General Strategies for the Management of Acute Chest Pain

  • Obtaining a thorough patient history is often the most valuable tool in coming to a diagnosis. In angina pectoris, for example, blood tests and other analyses are not sufficient to make a diagnosis (Chun & McGee 2004).
  • The physician's typical approach is to rule out the most dangerous causes of chest pain first (e.g., myocardial infarction, pulmonary embolism). By sequential elimination or confirmation from the most serious to the least serious cases, a diagnosis of the origin of the pain is eventually made. Emergency reperfusion therapy either by percutaneous coronary intervention or thrombolytic agents is recommended after diagnosis.
  • Often, no definite cause will be found, and the focus in these cases is on excluding severe conditions and reassuring the patient

Immediate Management

Acute coronary syndrome

Pulmomary embolism


Cardiac tamponade

Aortic dissection

  • Aortic dissection is almost always a surgical emergency[2].
  • The best test for diagnosis is CT angiography[3].
  • Aggressive controlling of hypertension is necessary and beta-blocker therapy is warranted to avert reflux tachycardia[4].

Gastresophageal reflux disease

  • It is important to differentiate between acute coronary syndrome and GERD in a patient presenting with burning chest pain.
  • Proton pump inhibitors and H2 blockers are the first-line recommended treatments for GERD[5].


  1. Johnson K, Ghassemzadeh S. PMID 29262011. Missing or empty |title= (help)
  2. Zhao DL, Liu XD, Zhao CL, Zhou HT, Wang GK, Liang HW, Zhang JL (October 2017). "Multislice spiral CT angiography for evaluation of acute aortic syndrome". Echocardiography. 34 (10): 1495–1499. doi:10.1111/echo.13663. PMID 28833419.
  3. Shiber JR, Fontane E, Ra JH, Kerwin AJ (June 2017). "Hydropneumothorax Due to Esophageal Rupture". J Emerg Med. 52 (6): 856–858. doi:10.1016/j.jemermed.2017.02.006. PMID 28336238.
  4. Khoynezhad A, Plestis KA (2006). "Managing emergency hypertension in aortic dissection and aortic aneurysm surgery". J Card Surg. 21 Suppl 1: S3–7. doi:10.1111/j.1540-8191.2006.00213.x. PMID 16492293.
  5. Alzubaidi M, Gabbard S (October 2015). "GERD: Diagnosing and treating the burn". Cleve Clin J Med. 82 (10): 685–92. doi:10.3949/ccjm.82a.14138. PMID 26469826.