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Chest pain at rest or during exercise may present in patients with cardiac problems or in otherwise healthy persons. It may be the first presentation of a potentially lethal condition and it should be evaluated in an emergency basis. Ideally, the time from symptom onset to first medical contact shoudl be minimized – every minute counts!

In the event that initial clinical ana laboratory evaluation (electrocardiography, serum biomarkers and/or echocardiography) is normal that, in most cases, further evaluation is recommended. This may be conducted in a non-emergent fashion.

Indeed, a series of potentially lethal conditions must be ruled-out; namely acute coronary syndromes, acute aortic dissection and pulmonary embolism. If such a condition is diagnosed timely interventions have a beneficial or even life-saving impact. A variety of extracardiac conditions may provoke a feeling of chest discomfort or pain like conditions affecting the oesophagus, the stomach, the hepatobillary system (liver), the muscles or even pshycological stress.

Unfortunatelly, chest pain represents a very generic symptom and even in its atypical or light intensity forms may be the expression of serious health conditions. Importantly, in the case of typical charasteristics (substernal chest pain with a character of burning or chest heavines radiating to the neck, left shoulder, or left arm), in the case of a very intense / aggressive symptom (e.g. acute presentation or resembling a feeling of scissoring cut), in the case that the patient is awaken during night sleep or in the first morning hours, in the case that the patient has already been diagnosed as high-risk or with positive medical history then evaluation should not be delayed.

It is undesrcored, that even a recent “negative” evaluation cannot always exclude the possibility of future adverse cardiovascular events. In this context, “symptom is the king” and the cardiologist should evaluate de novo the patient’s current clinical status taking of coure into account any former tests.