Harrison's Internal Medicine Part 2. Cardinal Manifestations and Presentation of Diseases Section 1. Pain Chapter 13. Chest Discomfort Chest Discomfort: Introduction Chest discomfort is one of the most common challenges for clinicians in the office or emergency department. The differential diagnosis includes conditions affecting organs throughout the thorax and abdomen, with prognostic implications that vary from benign to life-threatening (Table 13-1). Failure to recognize potentially serious conditions such as acute ischemic heart disease, aortic dissection, tension pneumothorax, or pulmonary embolism can lead to serious complications, including death. Conversely, overly conservative management of low-risk patients leads to unnecessary hospital admissions, tests,. | Chapter 013. Chest Discomfort Part 1 Harrison s Internal Medicine Part 2. Cardinal Manifestations and Presentation of Diseases Section 1. Pain Chapter 13. Chest Discomfort Chest Discomfort Introduction Chest discomfort is one of the most common challenges for clinicians in the office or emergency department. The differential diagnosis includes conditions affecting organs throughout the thorax and abdomen with prognostic implications that vary from benign to life-threatening Table 13-1 . Failure to recognize potentially serious conditions such as acute ischemic heart disease aortic dissection tension pneumothorax or pulmonary embolism can lead to serious complications including death. Conversely overly conservative management of low-risk patients leads to unnecessary hospital admissions tests procedures and anxiety. Table 13-1 Differential Diagnoses of Patients Admitted to Hospital with Acute Chest Discomfort Ruled Not Myocardial Infarction Diagnosis Percent Gastroesophageal disease 42 Gastroesophageal reflux Esophageal motility disorders Peptic ulcer Gallstones Ischemic heart disease 31 Chest wall syndromes 28 Pericarditis 4 Pleuritis pneumonia 2 Pulmonary embolism 2 Lung cancer Aortic aneurysm 1 Aortic stenosis
