Acute Chest Pain in the Young Adult


      The complaint of chest pain in an individual may be caused by a myriad of causes, including cardiac, pulmonary, gastrointestinal, and musculoskeletal causes. In the younger adult, it is uncommon for a serious cause of cardiac or pulmonary disease to be the etiology. This article presents 2 cases of adults under the age of 23 who presented to family practice clinicians and reviews 3 potentially life-threatening diagnoses (cardiomyopathy, pericarditis, and pericardial effusion). Patient presentation, diagnostic features, and treatment options are discussed for each of these diagnoses. New, emerging treatment options are also reviewed.


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        • Amsterdam E.A.
        • Kirk J.D.
        • Bluemke D.A.
        • et al.
        Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association.
        Circulation. 2010; 122: 1756-1776
        • Haasenritter J.
        • Aerts M.
        • Bösner S.
        • et al.
        Coronary heart disease in primary care: accuracy of medical history and physical findings in patients with chest pain—a study protocol for a systematic review with individual patient data.
        BMC Fam Pract. 2012; 13: 81
        • Bösner S.
        • Haasenritter J.
        • Becker A.
        • et al.
        Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule.
        CMAJ. 2010; 182: 1295-1300
        • Collin M.J.
        • Weisenthal B.
        • Walsh K.M.
        • et al.
        Young patients with chest pain: 1-year outcomes.
        Am J Emerg Med. 2011; 29: 265-270
        • Richardson P.
        • McKenna W.
        • Bristow M.
        • et al.
        Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies.
        Circulation. 1996; 93: 841-842
        • Luk A.
        • Ahn E.
        • Soor S.G.
        • Butany J.
        Dilated cardiomyopathy: a review.
        J Clin Pathol. 2009; 62: 219-225
        • Ferri F.
        Ferri's Clinical Advisor 2014. 1st ed. Mosby, Inc., Philadelphia, PA2013
        • Wexler R.K.
        Cardiomyopathy: an overview.
        Am Fam Physician. 2009; 79: 778-784
        • Sivagnanam K.
        • Chaudari D.
        • Lopez P.
        • Sutherland M.E.
        • Ramu V.K.
        “Bath salts” induced severe reversible cardiomyopathy.
        Am J Case Rep. 2013; 14: 288-291
        • Jordan J.T.
        • Harrison B.E.
        Bath salt ingestion: diagnosis and treatment of substance-induced disorders.
        J Nurse Pract. 2013; 9: 403-410
      1. Schiller NB, Ren X, Ristow B. Echocardiographic recognition of cardiomyopathies. UpToDate. Accessed August 13, 2013.

        • American College of Cardiology Fellows/American Heart Association
        2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults.
        Circulation. 2009; 119: e391-e479
        • Heart Failure Society of America
        Executive Summary: HFSA 2010 Comprehensive Heart Failure Practice Guideline.
        J Card Fail. 2010; 16: 475-539
        • Shammas N.W.
        • Padaria R.F.
        • Coyne E.P.
        Pericarditis, myocarditis, and other cardiomyopathies.
        Prim Care. 2013; 40: 213-236
        • Sheth S.
        • Wang D.D.
        • Kasapis C.
        Current and emerging strategies for the treatment of acute pericarditis: a systematic review.
        J Inflamm Res. 2010; 3: 135-142
      2. Imazio M. Clinical presentation and diagnostic evaluation of acute pericarditis. UpToDate. Accessed August 12, 2013.

        • Tingle L.E.
        • Molina D.
        • Calvert C.W.
        Acute pericarditis.
        Am Fam Physician. 2007; 76: 1509-1514
        • Knowlton K.U.
        • Savoia M.C.
        • Oxman M.N.
        Myocarditis and pericarditis.
        in: Mandell G.L. Bennett J.E. Dolin R. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingston Elsevier, Phildadelphia, PA2010: 1153-1172
        • Khandaker M.H.
        • Espinosa R.E.
        • Nishimura R.A.
        • et al.
        Pericardial disease: diagnosis and management.
        Mayo Clin Proc. 2010; 85: 572-593
        • Mattu A.
        • Martinez J.P.
        Pericarditis, pericardial tamponade, and myocarditis.
        in: Adams J.G. Emergency Medicine: Clinical Essentials. 2nd ed. Elsevier, Philadelphia, Pennsylvania2013: 514-520
        • Sharieff G.Q.
        • Tylie T.
        Pericarditis, myocarditis, and endocarditis.
        in: Baren J.M. Rothrock S.G. Brennan J.A. Brown L. Pediatric Emergency Medicine. Elsevier, Philadelphia, PA2008: 500-503
        • Lotrionte M.
        • Biondi-Zoccai G.
        • Imazio M.
        • et al.
        International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences.
        Am Heart J. 2010; 160: 662-670
        • Lewinter M.M.
        • Tischer M.D.
        Pericardial diseases.
        in: Bonow R.O. Mann D.L. Zipes D.P. Libby P. Braunwald's Heart Disease—A Textbook of Cardiovascular Medicine. 9th ed. Saunders, Philadelphia, Pennsylvania2012: 1651-1671
      3. Hoit B. Diagnosis and treatment of pericardial effusion. UpToDate. Accessed August 13, 2013.

        • Gumrukcuoglu H.A.
        • Odabasi D.
        • Akdag S.
        • Ekim H.
        Management of cardiac tamponade: a comperative study between echo-guided pericardiocentesis and surgery—a report of 100 patients.
        Cardiol Res Pract. 2011; 2011: 197838
      4. Mankad S, Sinak LJ. Technique of pericardiocentesis. UpToDate. Accessed August 13, 2013.


      Barbara Ann Mullen, FNP-BC, is a Commander in the Nurse Corps, US Navy at Branch Health Clinic, Washington Navy Yard in Washington, DC.