Chest pain is a very common chief complaint in the ER. Among the deadly conditions of the differential diagnoses include Acute Coronary Syndromes (STEMI, NSTEMI, UNSTABLE ANGINA), CHF Exacerbation, Pulmonary Embolism, unstable ECG rhythms, pneumo’s, dissections, valvular stenosis, pericarditis and asthma/copd exacerbations. 

The workup can include an ECG, Labs, Chest X-rays, ultrasounds, and CT scans. 

• ECG: Obtained within 10-15 minutes of the patient arriving as it can help identify signs of ischemia and ACS, as well as dangerous arrhythmias

• Labs: Can include Troponins, BNP, and a D-Dimer. A Basic Metabolic Panel (BMP) and a Complete Blood Count (CBC) is usually obtained as well. Troponin helps identify heart muscle damage, the BNP helps with identifying heart failure, and D-Dimer can help with identifying Pulmonary Embolisms. 

• Chest Xray: Helps look for pulmonary issues like pneumonia, pneumos and pleural effusions. Can also detect cardiomegaly. 

• Echocardiogram: Helps assess how well the heart is pumping (Ejection Fraction), valves, and heart muscle issues. 

• CT Scans: More detail of organ structures and vessels, for example if to rule out a Pulmonary Embolism.