Chest Pain

If you are having severe pain, crushing, squeezing, or pressure in your chest that lasts more than a few minutes, or if the pain moves into your neck, left shoulder, arm, or jaw, go immediately to a hospital emergency department. Do not drive yourself. Call 911 for emergency transport.

Chest pain is one of the most frightening symptoms you can have. It is sometimes difficult even for a doctor or other medical professional to tell what is causing chest pain and whether it is life threatening.

• Any part of the chest can cause pain in the chest, including the heart, lungs, esophagus, muscle, bone, and skin.
  
  
• Because of the complex nerve distribution in the body, chest pain may come from another part of the body.
  
  
• The stomach or other organs in the belly (abdomen), for example, can cause chest pain.

Potentially life-threatening causes of chest pain

• Heart attack (also known as an acute myocardial infarction, or MI): A heart attack occurs when blood flow to the arteries that supply the heart (coronary arteries) becomes blocked. With decreased blood flow, the muscle of the heart does not receive enough oxygen. This causes damage and deterioration of the heart muscle.
  
  
• Angina: Angina is chest pain related to an imbalance between the oxygen demand of the heart and the amount of oxygen delivered via the blood. It is caused by blockage or narrowing of the blood vessels that supply blood to the heart. Angina is different from a heart attack in that the arteries are not completely blocked. Also, angina causes little or no permanent damage to the heart. Stable angina occurs while exercising and goes away with rest. Unstable angina is not relieved by rest or actually occurs at rest.
  
  
• Aortic dissection: The aorta is the main artery that supplies blood to the vital organs of the body, such as the brain, heart, kidneys, lungs, and intestines. Dissection means a tear in the inner lining of the aorta. This can cause massive internal bleeding and interrupt blood flow to the vital organs.
  
  
• Pulmonary embolus: A pulmonary embolus is a blood clot in one of the major blood vessels that supplies the lungs. It is a potentially life-threatening cause of chest pain but is not associated with the heart.
  
  
• Spontaneous pneumothorax: This condition occurs when air enters the saclike space between the chest wall and the lung tissue. Normally, negative pressure in the chest cavity allows the lungs to expand. When a spontaneous pneumothorax occurs, air enters the chest cavity. When the pressure balance is lost, the lung is unable to reexpand. This is often called a collapsed lung.
  
  
• Perforated viscus: Perforated viscus is a hole or teat in the wall of any area of the gastrointestinal tract. This allows air to enter the abdominal cavity. Air in the abdominal cavity irritates the diaphragm, which can cause chest pain.
  
  
• Cocaine-induced chest pain: Cocaine causes the blood vessels in the body to constrict. This can decrease blood flow to the heart, which causes chest pain. Cocaine also accelerates the progression of atherosclerosis, which is a risk factor for a heart attack. Although cocaine can cause these changes in the body, the possibility of a heart attack cannot be ruled out without proper medical evaluation. Go to the nearest hospital emergency department for medical attention.

Causes of chest pain that are not life threatening include the following:

• Acute pericarditis: This is an inflammation of the pericardium, which is the sac that covers the heart.
  
  
• Mitral valve prolapse: Mitral valve prolapse is an abnormality of one of the heart valves in which the "leaves" of the valve bulge into the heart chamber during contraction. When this occurs, a small amount of blood flows backward in the heart.
  
  
• Pneumonia: Pneumonia is an infection of the lung tissue. Chest pain occurs because of inflammation to the lining of the lungs.
  
  
• Disorders of the esophagus: Chest pain from esophageal disorders can be alarming symptom because it often mimics chest pain from a heart attack.
  
  
  • Acid reflux disease (gastroesophageal reflux disease, or GERD) occurs when acidic digestive juices flow backward from the stomach into the esophagus. The resulting heartburn is sometimes experienced as chest pain.
    
    
  • Esophagitis is an inflammation of the esophagus.
    
    
  • Esophageal spasm is defined as excessive, intensified, or uncoordinated contractions of the smooth muscle of the esophagus.
  
  
• Costochondritis: This is an inflammation of the cartilage between the ribs. Pain is typically located in the mid chest, with intermittently dull and sharp pain that may be increased with deep breaths, movement, and deep touch.
  
  
• Herpes zoster: Herpes zoster, also known as shingles, is a reactivation of chickenpox. With shingles you get a rash, usually only on one small part of your body. The pain, which is often very severe, usually is confined to the area of the rash. The pain may precede the rash by 4-7 days. Risk factors include any condition in which the immune system is compromised, such as advanced age, HIV, or cancer. Herpes zoster is highly contagious, especially for the 5 days before and the 5 days after the appearance of the rash.

A heart attack is caused by coronary heart disease, or coronary artery disease. Heart disease may be caused by cholesterol buildup in the coronary arteries (atherosclerosis), blood clots, or spasm of the vessels that supply blood to the heart.

• Risk factors for a heart attack are high blood pressure, diabetes, smoking, high cholesterol, family history of heart attacks at young ages (younger than 60 years), one or more previous heart attacks, male gender, and obesity.
  
  
• Postmenopausal women are at higher risk than premenopausal women. This is thought to be due to loss of the protective effects of the hormone estrogen at menopause. It has been treated by hormone supplements (hormone replacement therapy, or HRT). Recently research findings have changed our thinking on HRT; long-term HRT is no longer recommended for most women.
  
  
• Use of cocaine and similar stimulants is a risk factor for heart attack.

Angina may be caused by spasm, narrowing, or partial blockage of an artery that supplies blood to the heart.

• The most common cause is coronary heart disease, in which a blood clot or buildup of fatty material inside the blood vessel (atherosclerosis) reduces blood flow but does not completely block the blood vessel.
  
  
• Angina can be triggered by exercise or physical exertion, by emotional stress, or by certain heart rhythm disorders (arrhythmias) that cause the heart to beat very fast.

Aortic dissection may be caused by conditions that damage the innermost lining of the aorta.

• These include uncontrolled high blood pressure, connective-tissue diseases, cocaine use, advanced age, pregnancy, congenital heart disease, and cardiac catheterization (a medical procedure).
  
  
• Men are at higher risk than women.
  
  
• A similar condition is aortic aneurysm. This is an enlargement of the aorta that can rupture, causing pain and bleeding. Aneurysms can occur in the aorta in the chest or the abdomen.

Risk factors for pulmonary embolus include sedentary lifestyle or obesity, prolonged immobility, fracture of a long bone of the legs, pregnancy, cancer, history or family history of blood clots, irregular heartbeat (arrhythmias), heart attack, or congestive heart failure. Women who use birth control pills and smoke cigarettes are at higher risk than women who have only one or neither of these risk factors.

Spontaneous pneumothorax occurs when the pressure balance between the sac that contains the lung and the outside atmosphere is disrupted.

• Injury to the chest that pierces through to the lung sac is the most common cause of this condition.
  
  
• This can be caused by trauma, as in a car wreck or bad fall, by a gunshot wound or stabbing, or in surgery.
  
  
• Other risk factors include AIDS-related pneumonia, emphysema, severe asthma, cystic fibrosis, cancer, and marijuana and crack cocaine use.

The viscus may be perforated by direct or indirect injury. Risk factors not related to trauma are untreated ulcers, prolonged or forceful vomiting, swallowing a foreign body, cancer, appendicitis, long-term steroid use, infection of the gallbladder, gallstones, and AIDS.

Pericarditis can be caused by viral infection, bacterial infection, cancer, connective-tissue diseases, certain medications, radiation treatment, and chronic renal failure.

• One life-threatening complication of pericarditis is cardiac tamponade.
  
  
• Cardiac tamponade is an accumulation of fluid around the heart.
  
  
• This prevents the heart from effectively pumping blood to the body.
  
  
• Symptoms of cardiac tamponade include sudden onset of shortness of breath, fainting, and chest pain.

Mitral valve prolapse is thought to be an inherited birth disorder and affects as much as 10 percent of the population, mostly women. People with connective-tissue diseases and skeletal abnormalities (such as severe curvature or straightening of the spine or a concave chest) are at increased risk for this disorder.

Pneumonia may be caused by viral, bacterial, or fungal infections of the lungs.

Chest pain originating from the esophagus may have several causes.

• Acid reflux (GERD) may be caused by any factors that decrease the pressure on the lower part of the esophagus, decrease movement of the esophagus, or prolong emptying of the stomach. This condition may be brought on by consumption of high-fat foods, nicotine use, alcohol use, caffeine, pregnancy, certain medications (for examples, nitrates, calcium channel blockers, anticholinergics, estrogen, progesterone), diabetes, or scleroderma.
  
  
• Esophagitis may be caused by yeast, fungi, viruses, bacteria, or irritation from medications.
  
  
• Esophageal spasm is caused by excessive, intensified, or uncoordinated contractions of the smooth muscle of the esophagus. Spasm may be triggered by emotional upset or swallowing very hot or cold liquids.

Typical heart attack pain occurs in the mid to left side of the chest and may also extend to the left shoulder, the left arm, the jaw, the stomach, or the back.

• Other associated symptoms are shortness of breath, increased sweating, nausea, and vomiting.
  
  
• Symptoms vary considerably from person to person.

Angina is similar to heart attack pain but occurs with physical exertion or exercise and is relieved by rest or nitroglycerin.

• Angina becomes life threatening when pain occurs at rest, has increased in frequency or intensity, or is not relieved with at least 3 nitroglycerin tablets taken 5 minutes apart.
  
  
• This is considered to be unstable angina, which may be a warning sign of an impending heart attack.

The chest pain associated with aortic dissection occurs suddenly and is described as "ripping" or "tearing."

• The pain may radiate to the back or between the shoulder blades.
  
  
• Because the aorta supplies blood to the entire body, symptoms may also include angina-type pain, shortness of breath, fainting, abdominal pain, or symptoms of stroke.

Symptoms of a pulmonary embolus are sudden onset of shortness of breath, rapid breathing, and sharp pain in the mid chest, which increases with deep breaths.

Symptoms of pneumothorax are sudden onset of shortness of breath, sharp chest pain, rapid heart rate, and dizziness, light-headedness, or faintness.

Perforated viscus comes on suddenly with severe abdominal, chest, and/or back pain. Abdominal pain may increase with movement or when breathing in and may be accompanied by a rigid, boardlike abdominal wall.

The pain of pericarditis is typically described as a sharp or stabbing pain in the mid chest, worsened by deep breaths.

• This pain may mimic the pain of a heart attack, because it may radiate to the left side of the back or shoulder.
  
  
• One distinguishing factor is that the pain is worsened by lying flat and improved by leaning forward. When lying flat, the inflamed pericardium is in direct contact with the heart and causes pain. When leaning forward, there is a space between the pericardium and the heart.
  
  
• Many people report a recent cold, fever, shortness of breath, or pain when swallowing just before developing pericarditis.

Mitral valve prolapse usually has no symptoms, but some people experience palpitations (sensation of rapid or strong heart beat) and chest pain.

• Chest pain associated with mitral valve prolapse differs from that of typical angina in that it is sharp, does not radiate, and is not related to physical exertion.
  
  
• Other symptoms include fatigue, light-headedness, and shortness of breath.
  
  
• Anxiety also seems to be more common in people with mitral valve prolapse than in the general population.
  
  
• Complications include infection of the heart valves, migraine headaches, stroke or mini-stroke, and abnormal heart rhythms, which rarely cause sudden death.

The chest pain of pneumonia occurs during prolonged or forceful coughing.

With chest pain originating from the esophagus, symptoms depend on the source.

• Symptoms of gastroesophageal reflux disease (GERD) include heartburn, painful swallowing, excessive salivation, dull chest discomfort, chest pressure, or severe squeezing pain across the mid chest. You may appear comfortable or may experience profuse sweating, pallor, nausea, and vomiting. Other symptoms include sore throat, sour or bitter taste in the mouth or throat, hoarseness, and persistent dry cough. Pain from GERD is often relieved with antacids.
  
  
• Symptoms of esophagitis include difficulty swallowing, painful swallowing, or symptoms of GERD. The chest pain comes on suddenly and is not relieved by antacids.
  
  
• The pain of esophageal spasm is usually intermittent and dull. It is located in the mid chest and may radiate to the back, neck, or shoulders.

If you have any symptoms of chest pain, especially if the pain is new, you may call your doctor.

• However, it may be best to call 911 for emergency transport or go to the nearest hospital emergency department. Do not try to drive yourself.
  
  
• Because so many causes of chest pain often mimic a heart attack or other life-threatening illnesses, it is best to seek medical attention as quickly as possible.

If you suspect that you may be having a heart attack or other life-threatening chest pain, call 911 or go to the nearest hospital emergency department. Do not try to drive yourself.

• If you are having a heart attack, time is muscle. The longer you wait to receive evaluation and treatment, the more heart muscle is damaged.
  
  
• If there is something serious going on that is causing your chest pain, doctors can choose from many effective early interventions to reduce your chances of dying or becoming severely ill. These treatments can have a positive effect on the long-term quality of your life.

What if it turns out not to be a heart attack or other life-threatening event?

• You won’t know until the medical professionals at the hospital check out the cause of your chest pain. Give yourself that peace of mind.
  
  
• If your chest pain is not life threatening, you should not feel embarrassed or that you "wasted everyone's time." Whatever the outcome, you always make the correct choice by going to the nearest hospital emergency department.

Chest pain, regardless of whether it is caused by a life-threatening condition, needs to be evaluated by a medical professional. Be reassured that you are making the right decision and feel comfortable seeking emergency care whenever you experience chest pain.

In the hospital emergency department, the health care providers you see use 3 basic procedures to decide if you are having a heart attack.

• The first is the symptoms you report.
  
  
• The second is an electrocardiogram (ECG), an electrical tracing of the heart’s activity. On the ECG, it may be possible to tell which vessels in the heart are blocked or narrowed.
  
  
• The third is measurement of enzymes given off by the heart when it does not receive enough oxygen. These enzymes are detectable with blood tests.

Angina is diagnosed by the same methods doctors use to diagnose heart attacks.

• In angina, however, the test results reveal no permanent damage to the heart.
  
  
• The diagnosis is made only after the possibility of a heart attack has been ruled out, usually by negative results on 3 sets of cardiac enzyme tests.
  
  
• Although the ECG may show abnormalities, these changes are often reversible.
  
  
• Another way to diagnose angina is the "stress test": these tests monitor your ECG during exercise or other stress to identify blockages in blood vessels to the heart.
  
  
• Cardiac catheterization also is used to identify blockages. This is a special type of x-ray (angiography or arteriography) that uses a harmless dye to highlight blockages or other abnormalities in blood vessels.

The diagnosis of aortic dissection is based on the symptoms you describe, chest x-ray, and other special imaging tests.

• On a chest x-ray, the aorta will have an abnormal contour or appear widened.
  
  
• Transesophageal echocardiography is a specialized ultrasound of the heart in which a probe is inserted into the esophagus. The technique is performed under sedation or general anesthesia.
  
  
• The dissection may be identified very accurately by a CT scan of the chest or angiography.

The diagnosis of pulmonary embolism is made from a variety of sources.

• Your description of your symptoms and results of ECG and chest x-ray all may contribute to the diagnosis, but are not definitive.
  
  
• You will be asked if you have had any symptoms of a blood clot in the leg.
  
  
• You may have blood drawn from an artery to check the levels of oxygen and other gases. Abnormalities in blood gases indicate a problem in the lungs that is preventing you from getting enough oxygen.
  
  
• A ventilation-perfusion scan compares blood flow to oxygen intake in different segments of the lung. An irregularity in just one segment can indicate an embolism.
  
  
• Only angiography offers definitive diagnosis.

Spontaneous pneumothorax is diagnosed by physical exam and chest x-ray. A CT scan may be helpful in locating a small pneumothorax.

Perforated viscus usually can be identified by a chest x-ray with you standing upright or an abdominal x-ray with you lying on the left side.

• X-rays in these positions allow air to rise to the diaphragm, where it can be detected.
  
  
• Your symptoms and the results of your physical exam and other lab tests also assist in diagnosis.

Acute pericarditis is usually diagnosed by your symptoms, serial ECGs, and echocardiography. Certain lab tests may be helpful in determining the cause.

Mitral valve prolapse is detected by physical exam and an echocardiogram, which allows observation of the valve's actions while the heart beats and rests. This condition sometimes is linked to a variety of abnormal findings on ECG.

Pneumonia is diagnosed by symptoms and medical history, physical examination, and chest x-ray.

Disorders of the esophagus causing chest pain are diagnosed by a process of elimination. The diagnosis is made on the basis of your symptoms and your medical history, after ruling out heart causes and observing whether you get pain relief from antacids.

|Self-Care at Home|

If you suspect that you may be having a heart attack, call 911 for emergency services or go to the nearest hospital emergency department.

• While you are waiting for the ambulance, chew 2 baby aspirin or at least half of a regular aspirin—a total of at least 160 mg. There is no evidence that taking more than this helps more, and you could have unwanted side effects if you take too much.
  
  
• It is important to chew the aspirin before swallowing it because chewing decreases the time the medicine takes to have an effect.
  
  
• Chewing an aspirin in the early stages of a heart attack may reduce the risk of death by as much as 23%.

If you have had angina and have nitroglycerin tablets available, place one under your tongue. This may aid in increasing blood flow to blocked or narrowed arteries.

• If your chest pain continues in the next 5 minutes, you should take another tablet under the tongue.
  
  
• If, after 3 nitroglycerin tablets, you do not have relief of the chest pain, you should immediately call 911 or go to the nearest emergency department.

If the pain is from acid reflux (GERD), it may be relieved with antacids. Even if your pain goes away after you take an antacid, you should not assume you are not having a heart attack. You should still be evaluated in a hospital emergency department.

|Medical Treatment|

Treatment for a heart attack is aimed at increasing blood flow by opening arteries blocked or narrowed by a blood clot.

• Medicines used to achieve this include aspirin, heparin, and "clot-busting" (thrombolytic) drugs.
  
  
• Other medications can be used to slow the heart rate, which decreases the workload of the heart and reduces pain.
  
  
• Angioplasty is a way of unblocking an artery. Angiography is done first to locate narrowing or blockages. A very thin plastic tube called a catheter is inserted into the artery. A tiny balloon on the end of the catheter is inflated. This expands the artery, providing a wider passage for blood. The balloon is then deflated and removed. Sometimes a small metal "scaffold" called a stent is placed in the artery to keep it expanded.
  
  
• Surgery may be required if medical treatment is unsuccessful. This could include angioplasty or cardiac bypass.

Treatment of angina is directed at relieving chest pain that occurs as the result of reduced blood flow to the heart.

• The medication nitroglycerin is the most widely used treatment. Nitroglycerin dilates (widens) the coronary arteries. It is often taken under the tongue (sublingually).
  
  
• People with known angina may be treated with nitroglycerin for 3 doses, 5 minutes apart.
  
  
• If the pain remains, nitroglycerin is given by IV, and the person is admitted to the hospital and monitored to rule out a heart attack.
  
  
• Long-term treatment after the first episode of angina focuses on reducing risk factors for atherosclerosis and heart disease.

Suspected aortic dissection often is treated with medications that reduce blood pressure.

• Medications that slow the heart rate and dilate the arteries are the most widely used.
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• Close monitoring is required to avoid lowering the blood pressure too much, which can be dangerous.
  
  
• Surgical repair is required for any dissection that involves the ascending (upward) portion of the aorta.

Anyone with a presumed or documented pulmonary embolism requires admission to the hospital.

• Treatment usually includes supplemental oxygen and medication to prevent further clotting of blood, typically heparin.
  
  
• If the embolism is very large, "clot-busting" medications are given in some situations to dissolve the clot.
  
  
• Some people undergo surgery to place an umbrellalike filter in a blood vessel to prevent blood clots from the lower extremities from moving to the lungs.

Spontaneous pneumothorax without symptoms involves 6 hours of hospital observation and repeat chest x-rays.

• If the size of the pneumothorax remains unchanged, you usually are discharged with a follow-up appointment in 24 hours.
  
  
• If you develop symptoms or the pneumothorax enlarges, you will be admitted to the hospital. You will undergo catheter aspiration or have a chest tube inserted to restore negative pressure in the lung sac.

Any disruption or perforation of the intestinal tract (viscus) is a potentially life-threatening emergency. Immediate surgery may be required.

Viral pericarditis usually improves with 7-21 days of therapy with nonsteroidal anti-inflammatory agents such as aspirin and ibuprofen (Motrin, for example).

Mitral valve prolapse is usually treated conservatively, which means with surgery or other invasive treatments.

• Medications to control palpitations and chest pain are the usual treatment.
  
  
• When the condition is severe and does not respond to medical treatment, an operation to replace the valve is needed.
  
  
• If you have mitral valve prolapse, you should take antibiotics before any high-risk surgery or dental work.
  
  
• This reduces the risk of endocarditis, an infection of the heart valves.

Pneumonia is treated with antibiotics, and pain medication is given for chest wall tenderness.

Costochondritis is usually treated with nonsteroidal anti-inflammatory medication such as ibuprofen.

The 3 major esophageal disorders that cause chest pain—acid reflux (GERD), esophagitis, and esophageal spasm—are treated with antacid therapy; antibiotic, antiviral, or antifungal medication; medication to relax the muscles of the esophagus; or some combination of these.

|Follow-up|

No matter what the cause of chest pain, regular follow-up visits with your health care provider are important. This will help you remain as healthy as possible and prevent worsening of your condition.

|Prevention|

Prevention of heart attack and angina involves living what the American Heart Association calls a "heart healthy" lifestyle. Reducing your risk factors has a significant effect on reducing your risk.

• Don't smoke.
  
  
• Maintain a healthy weight.
  
  
• Eat nutritious, low-fat foods in moderate quantities.
  
  
• Use alcohol moderately, if at all.
  
  
• Engage in physical activity or exercise for at least 30 minutes every day.
  
  
• Control high blood pressure and high cholesterol.
  
  
• If you have diabetes, control your blood sugar every day.

Aortic dissection may be prevented by controlling your high blood pressure.

Prevention of pulmonary embolism includes living a heart healthy lifestyle.

• No one should smoke, but women older than 35 years who use birth control pills are at especially high risk from smoking.
  
  
• You should always receive preventive anticoagulant medication after surgery, especially after orthopedic surgery.

Smoking cessation decreases the risk of spontaneous pneumothorax.

Treating peptic ulcers appropriately and avoiding swallowing foreign bodies reduce your risk of perforated viscus.

Because many cases of acute pericarditis are caused by viruses, effective handwashing may reduce transmission of infectious viral agents. Effective handwashing and good hygiene will help reduce the transmission of infectious viruses and bacteria that can cause pneumonia.

There is no true prevention for mitral valve prolapse.

Acid reflux (GERD) can be prevented to a certain extent in most people.

• Avoid foods and other substances that bring on or worsen symptoms, especially fatty foods
  
  
• Stop smoking
  
  
• Use alcohol in moderation, if at all
  
  
• Avoid eating large meals
  
  
• Avoid eating for 3 hours before bedtime
  
  
• Avoid lying down right after eating
  
  
• Elevate the head of your bed

|Outlook|

Early medical intervention improves survival in potentially life-threatening illnesses involving chest pain.

Heart attack and unstable angina: Heart disease, which includes heart attacks and angina, is the leading cause of death for American adults. Almost 1 million people die each year from this disease. Whether you survive a heart attack depends on the time it takes to get medical treatment, the region and extent of injury within the heart, and the presence of any other risk factors.

Aortic dissection: Quick action in getting medical treatment is essential with aortic dissection. Up to 20% of people with aortic dissection who receive medical treatment but not surgery die. Of those who undergo surgery, about 7% die.

Pulmonary embolism: Even with early treatment, 1 in 10 people with pulmonary embolism die within the first hour. One third are treated with a good outcome. Two thirds of cases of pulmonary embolism go undiagnosed, and one third of these people die of the condition.

Spontaneous pneumothorax: Ninety-five percent of people with this condition recover fully. Other illnesses causing pneumothorax and complications from the chest tube placement may prolong or worsen the condition.

Perforated viscus: With early detection and intervention, the prognosis for perforated viscus is good.

Acute pericarditis: Although the course may vary with each person, an estimated 60% recover completely within 1 week, and another 20% recover completely within 3 weeks. Only 3% of people have symptoms lasting more than 3 weeks. For about 15% of people, symptoms return within a year.

Mitral valve prolapse: Overall, the outlook is good. The complication rate is low.

Pneumonia: In young, healthy adults, the prognosis for pneumonia is good with appropriate treatment. Prognosis is generally poorer in the elderly and in people with weakened immune systems such as those with HIV/AIDS.

Chest pain originating from the esophagus: Reflux disease (GERD) affects about one fourth of the adult population and has a very low death rate. Esophagitis may lead to ulcerations, scarring, or narrowing of the esophagus. With the exception of possible perforation, which has a high death rate, the overall prognosis is good. Esophageal spasm has a good outcome.

American Heart Association
National Center
7272 Greenville Avenue
Dallas, TX 75231
(800) 242-8721

|Web Links|

American Heart Association

North American Society of Pacing and Electrophysiology

Media file 1: Sources and locations of different causes of chest pain. Adapted from Hill B and Geraci S. A diagnostic approach to chest pain based on history and ancillary evaluation.

Media type:  Image

Media file 2: Spontaneous pneumothorax. Left: Normal lung with positive pressure outside of the thorax. Right: Positive pressure within the thoracic cavity preventing expansion of the lung.

Media type:  Image

Media file 3: Herpes zoster. From Knoop, K. Atlas of Emergency Medicine. New York: McGraw-Hill, 1997.

Media type:  Photo

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Author: Estelle Vaughns Williams, MD, Attending Physician, Department of Emergency Medicine, St Luke's Roosevelt Medical Center.

Coauthor(s): Marian Gambrell, MD, Clinical Assistant Professor, Department of Emergency Medicine, St Lukes-Roosevelt Hospital Center, Columbia University.

Editors: Jeter (Jay) Pritchard Taylor III, MD, Vice-Chief, Compliance Officer, Attending Physician Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Michael E Zevitz, MD, Clinical Assistant Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science, Chicago.