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


Iatrogenic related to cardiac catheterisation

Coarctation of the aorta


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