Table 1.

Modified from ACCA clinical decision-making toolkit¹⁰

Causes of chest pain/discomfort not related to ACS

Cardiovascular

Acute pericarditis, pericardial effusion

Acute myocarditis

Severe hypertensive crisis

Stress induced cardiomyopathy (Takotsubo-like syndrome)

Hypertrophic cardiomyopathy, aortic stenosis

Acute left ventricular failure

Acute aortic syndrome (dissection, aortic ulcer, intramural haematoma)

Pulmonary embolism, pulmonary infarction, severe pulmonary hypertension

Cardiac contusion

Acute bio or mechanical prosthetic valve failure/malfunction

Non-cardiovascular

Oesophageal spasm, oesophagitis, gastroesophageal reflux disease

Peptic ulcer, acute cholecystitis-pancreatitis

Pneumonitis, bronchitis, asthma attack

Pleurisy, pleural effusion, pneumothorax

Chest injury

Costochondritis, rib fracture

Damage to cervical/thoracic vertebrae or discs

Herpes zoster

Anxiety, depression