ABSTRACT
Pleuritic chest pain is characterised by being well localised, sharp in nature and exacerbated by inspiration. Chest pain that does not have these characteristics is described as non-pleuritic. The main focus of investigation should be on diagnosing or excluding an acute coronary syndrome. Other serious, but less common, causes of acute chest pain include aortic dissection and oesophageal rupture. Oesophageal rupture requires vigorous fluid resuscitation, broad-spectrum antibiotics and urgent surgical intervention. Palpate the pulse, noting the rate, rhythm, character and volume. Radio-radial or radio-femoral delay may occur with aortic dissection. Inspect and palpate the chest wall carefully for local tenderness and swelling. Tenderness and/or swelling over the costochondral joints suggest costochondritis, particularly if palpation reproduces the patient's pain. Tender spots in other areas of the chest may be associated with rib fractures, muscle tears or chest wall trauma. Check for the rash of shingles.
