Clinical Scenarios

Clinical Scenario

Chest Pain


By the end of Family Medicine Clerkship, students will be able to:

Preamble: The following objectives apply to chest pain presenting in the ambulatory care setting (ie. not an Emergency department).

1. Conduct a rapid assessment to identify patients requiring emergency care
2. Describe the family physicians role in the stabilization and initial management of patients identified to require emergent care.
3. Conduct a focused history (including cardiac risk factors) and a relevant physical exam
4. Develop a concise differential diagnosis for patients with chest pain including cardiac and non- cardiac causes.
5. Describe the key clinical characteristics of the following chest pain etiologies: angina, embolism, gastroesophageal reflux, costochondritis, anxiety, pneumonia.

Clinical Cards



Recommended Resources Addressing the Objectives

Overview of diagnosis and mgmt of acute chest pain in outpatient adults (6 pages)

Objectives covered: All
McConaghy JR, Oza RS. Outpatient diagnosis of acute chest pain in adults. Am Fam Physician 2013 Feb 1;87(3):177-182.

Foundational Knowledge

The Calgary Guide – How the five classic cardiac risk factors contribute to atherosclerosis and heart disease

Additional Resources

Chest pain top 10 diagnoses in family medicine + quick clinical pearls (1 page)

Objectives covered: 3 and 4
Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: chest pain. Can Fam Physician 2007 Dec;53(12):2146.

Instructional videos on conducting a chest examination

(See other references attached)