Assessing cardiac chest pain in prescribing practice

In England and Wales, myocardial ischaemia (also known as ischaemic heart disease) was the number one cause of death in men in 2022, with 38 730 deaths, accounting for 13.3% of all male deaths. For women, dementia and Alzheimer's was the number one cause that year, accounting for 15% of female death (Office for National Statistics (ONS), 2022). Myocardial ischaemia is also the most common cause of cardiac chest pain.

Of course, there are many causes of chest pain, including non-cardiac and cardiac causes. Non-cardiac chest pain may be caused by gastrointestinal causes such as gastro-oesophageal reflux disorder (GORD) or gallbladder disease; respiratory causes such as a pulmonary embolus (blood clot in the lungs) or a chest infection, i.e. pneumonia; or musculoskeletal causes such as an inflammation of the costochondrial muscles (i.e. costochondritis) or physical trauma or degenerative changes (Paine, 2024). Such non-cardiac causes would need to be ruled out before a confident cardiac diagnosis can be made. This can be done by considering history of chest pain; presence of cardiovascular risk factors; history of myocardial ischaemia and any prior treatment; and past investigations for chest pain (National Institute for Health and Care Excellence (NICE), 2010).