Chest Pain History: A Starting Point
The history does, however, form a start point in the diagnostic process, broadly establishing whether pain is likely to be cardiac ischaemic (or not) in origin; it provides information to add to baseline risk factors (see Table 4) which makes the diagnosis of ACS significantly more or less likely. Specifically, radiation of the pain to the arms or shoulders, and its association with exertion or diaphoresis will make the diagnosis more likely.
Table 4: Risk factors associated with major life-threatening causes of chest pain
| Condition | Risk Factors |
| Acute coronary syndromes | Previous known coronary artery disease (previous myocardial infarction, angioplasty, etc) Positive family history Advanced age, male gender Diabetes, hypertension, hypercholesterolaemia Active smoker, obesity, sedentary lifestyle Aspirin usage |
| Aortic dissection(6,7) | Chronic hypertension Inherited connective tissue disorder e.g. Marfans Syndrome, Ehlers-Danlos Syndrome Bicuspid aortic valve Atheroscleroisis Iatrogenic related to cardiac catheterisation Coarctation of the aorta Pregnancy Cocaine use Inflammatory aortic disease e.g. Giant Cell Arteritis |
| Pulmonary embolism(8,9) | Previous history of venous thromboembolic disease Pregnancy particularly 6 weeks post partum Positive family history of venous thromboembolic disease (two or more family members) Recent prolonged immobilisation (> 3 days) Major surgery within previous 12 weeks Fracture of lower limb within previous 12 weeks Active cancer (within previous 6 months, recent treatment, palliation) Lower extremity paralysis |