Chest pain is a common symptom reported in both primary care and acute care settings. Every year in the United States more than 5 million persons present to emergency departments with the primary complaint of chest pain. Yet chest pain remains one of the most difficult and complex diagnostic challenges. It is the presenting symptom for a variety of conditions, ranging from muscle strain to life-threatening conditions such as dissecting thoracic aortic aneurysm and acute myocardial infarction. Thus, cardiovascular nurses, regardless of the setting in which they work, need to be able to quickly evaluate the patient, considering the conditions that carry the greatest morbidity and mortality.

This issue of the Journal of Cardiovascular Nursing (JCN) includes a series of articles on the most life-threatening causes of chest pain. The series is designed to review, and update cardiovascular nurses on, the presenting symptoms and characteristics of each condition, physical examination findings, and diagnostic tests that help distinguish the various etiologies. It is beyond the scope of this series to address the treatment strategies for each of these complex conditions.

The series begins with an overview of a structured approach to evaluating the cause of chest pain. A careful history is the most important component of the initial evaluation process. When interviewing the patient, it is helpful to use a mental checklist to include the historical features that help distinguish cardiac from noncardiac chest pain. This article uses the APQRST mnemonic as an approach to help clinicians gather relevant data that is central to thoughtful decision making.

Coronary heart disease remains the leading cause of death in the United States. Doctors DeVon and Ryan discuss the symptoms, evaluation, and assessment of patients who present with chest pain due to acute coronary syndrome. They review the characteristics of patients who delay in seeking treatment for chest pain and the implications for nurses as we strive to improve patient outcomes.

Chest pain and fever are the most common symptoms in patients with pericarditis. Authors Carter and Brooks, clinical experts, review the etiology, essential components of the history, physical assessment, and diagnostic evaluation of pericarditis to assist the clinician in promptly identifying pericarditis and avoiding life-threatening complications such as cardiac tamponade.

Severe chest pain is the most common presenting symptom in patients with thoracic aortic aneurysm and dissection. Unfortunately, this condition is associated with high rates of mortality, and the prevalence appears to be increasing. Ms Klein, a clinical nurse specialist, discusses the clinical presentation, physical examination, and appropriate diagnostic studies for thoracic aortic aneurysm and dissection. Because classic physical findings are often absent, a careful history and appropriate diagnostic testing are essential for early recognition and successful outcomes for this life-threatening condition.

Dyspnea commonly accompanies chest pain and may be a hallmark for pneumothorax and pulmonary emboli. Pneumothorax must be considered in the differential of chest pain, because pneumothorax may progress to tension pneumothorax, a life-threatening complication. Ms Ryan, an acute care nurse practitioner, describes primary and secondary pneumothorax and appropriate evaluation strategies.

Early recognition is the key to lowering mortality in patients with pulmonary embolism. Unfortunately, death from pulmonary embolism most often occurs from an inaccurate diagnosis. The signs and symptoms of pulmonary embolism may be quite subtle, but the most common symptoms are dyspnea and chest pain. As Ms Charlebois, an acute care nurse practitioner points out, identification of patients at risk for developing pulmonary embolism may be most effective in reducing the mortality due to this condition.

Regardless of the setting in which we practice, cardiovascular nurses often encounter patients experiencing chest pain. It is our hope that the information in these articles will help you identify patients at risk and improve the outcomes of these serious conditions.

Juanita Reigle, MSN, RN, ACNP

Guest Editor