Evaluation of Chest Pain in Young Adults

Initial Assessment

The American Heart Association recommends considering cardiac causes in women presenting with chest pain, even in young patients, as they are at risk for underdiagnosis 1, 2, 3, 4
A focused history should include pain characteristics, duration, associated features, and cardiovascular risk factor assessment, as recommended by the American College of Cardiology 2, 5
Pain characteristics that suggest cardiac origin include retrosternal chest discomfort, pain that gradually builds in intensity, and pain precipitated by physical exercise or emotional stress 1, 3, 5
The American College of Cardiology suggests that women presenting with chest pain should be assessed for accompanying symptoms more common in women with acute coronary syndrome, including palpitations, jaw and neck pain, and shortness of breath 1, 2, 3, 4

The American Heart Association recommends performing a 12-lead ECG for patients with stable chest pain, unless a noncardiac cause is evident 2
A normal ECG in a patient without cardiac history or risk factors suggests a low risk of acute coronary syndrome, as stated by the American College of Cardiology 2
The American College of Cardiology recommends measuring cardiac troponin as soon as possible if acute coronary syndrome is suspected, and transporting the patient to the emergency department if troponin is elevated or the ECG shows ischemic changes 2, 6

The American College of Cardiology suggests performing a focused cardiovascular examination to aid in diagnosis and identify complications 2, 4
Key examination findings include chest wall tenderness, costochondritis, epigastric tenderness, and fever with localized chest pain 1, 3, 4, 6

The American Heart Association recommends a risk-stratified approach, with very low-risk patients (no cardiac history, no risk factors, normal ECG) pursuing non-cardiac diagnoses without cardiac biomarkers or stress testing 6
The American College of Cardiology suggests that low-to-intermediate risk patients (some risk factors or abnormal ECG) should have cardiac troponin measured and be transported to the emergency department if elevated or if the ECG shows ischemic changes 2, 6