Table 2

Clues in history to causes of chest pain

CardiacAssociation with exercise
Syncope, dizziness, vertigo
Colour change (pallor, cyanosis)
Sweating and nausea
Shortness of breath
Family history of premature ischaemic heart disease, sudden death, arrhythmia and cardiomyopathy
Illicit drug use, particularly cocaine
RespiratoryWorse on inspiration, exercise
History of asthma
Sputum, haemoptysis
GastrointestinalWorse with eating or posture
Tenderness or pain — chest base, shoulder tip, retrosternal, epigastric
Heartburn, water-brash
Haematemesis, melaena
MusculoskeletalPain elicited by palpation, squeezing of chest wall
Pain worse on movement, breathing, coughing
History of trauma, sprain, strain
Well-localised pain
PsychologicalChronic pain
Pain as isolated symptom
Family history of heart disease
Stressful life events