Chest Pain with Shortness of Breath: Cardiac, Pulmonary, and Other Causes

Chest pain plus dyspnea is a high-acuity presentation requiring prompt triage. The differential spans life-threatening to benign conditions.

Cardiac (Urgent)

• Acute coronary syndrome (STEMI/NSTEMI): Pressure-like pain, radiation, diaphoresis, nausea. ECG, troponin.
• Unstable angina: Crescendo pattern, rest pain.
• Acute heart failure: Orthopnea, PND, crackles, elevated JVP, BNP.
• Pericarditis: Pleuritic, positional, friction rub, diffuse ST elevation.
• Aortic dissection: Tearing, radiating to back, pulse deficits, widened mediastinum.

Pulmonary

• Pulmonary embolism: Sudden pleuritic pain, tachycardia, hypoxia, risk factors (DVT, immobility). CT angiography.
• Pneumothorax: Sudden unilateral pain, absent breath sounds. CXR.
• Pneumonia: Fever, productive cough, consolidation on imaging.
• COPD/asthma exacerbation: Wheezing, prolonged expiration, known history.

GI & Musculoskeletal

• GERD (burning, regurgitation), esophageal spasm, pancreatitis (epigastric, radiating to back).
• Costochondritis (reproducible tenderness), rib fracture.

Psychogenic

Panic attack: hyperventilation, paresthesias, sense of doom; diagnosis of exclusion.

Immediate Action

Call emergency services if pain is crushing, radiates, associated with syncope, diaphoresis, or hemodynamic instability. Chew 325 mg aspirin if no allergy/contraindication while awaiting EMS.