Chest pain (chestpain) is a common symptom that can be clinically significant, so the first priority in the diagnosis of chest pain is to rule out fatal conditions such as acute myocardial infarction, acute pulmonary embolism, aortic coarctation, tension pneumothorax, and acute abdomen. For patients with chest pain, it is best to find the cause. I. Diagnostic considerations (a) Medical history 1, the onset of the delay, duration, severity, pain site, nature, with or without radiation. 2, chest pain and whooping, coughing, swallowing, physical activity, emotional excitement has no relationship. Accompanying symptoms: coughing up sputum, hemoptysis, dysphagia, dysphagia, acid reflux, heartburn, palpitation, forced position, fever, edema and so on. 4.Has there been any similar episodes in the past, how to treat, what kind of drugs have been used, how responsive to the drugs. 5.History of chest surgery, history of trauma. 6.With or without cardiovascular disease risk factors. （Physical examination: 1. Any abnormalities of the chest wall and localized tenderness, including skin, ribs and intercostal nerves. 2. 2.Whether there are signs of pathology of the whistle and circulatory system, and if necessary, measure the blood pressure of the limbs. (3) Any deformity, pressure and percussion pain in the crista. (C) Other examinations 1, electrocardiogram, chest X-ray. 2, Echocardiography. 3, Laboratory tests: blood routine, cardiac enzyme spectrum, D-dimer, etc.. 4, Crest X-ray, MRI if necessary. 5.CT examination: including coronary artery CT angiography and CT pulmonary arteriography, etc. 6, Coronary arteriography. 7, digestive system related examination: such as 24-hour esophageal acid measurement, gastroscopy, abdominal plain film, abdominal ultrasound, etc. II. Differential Diagnosis (I) Chest pain caused by chest wall diseases, with clear localization, limitation, and mostly positive localization, such as rashes, redness, swelling, compression pain, and deformity. (ii) Crestal diseases compressing the nerve roots, with stabbing, electric shock and tearing pains, mostly episodic. It may extend to areas away from the irritation. Examination of the crestal column reveals deformity, pressure, and percussion pain, and the pain occurs or worsens when the body is twisted or a heavy object is held. (c) Retrosternal pain associated with swallowing is seen in diseases of the esophagus and mediastinum. If it is accompanied by heartburn and acid reflux, it is a typical clinical manifestation of reflux esophagitis. (d) Chest pain accompanied by cough and aggravated by coughing and deep whistling indicates that the lesion has invaded the pleura, which can be seen in pneumonia, tuberculosis, lung abscess and pleurisy. (E) Chest pain occurs during labor, full meal or emotional excitement, which should be considered as angina pectoris, myocardial infarction or aortic coarctation. (F) Sudden severe chest pain, in addition to trauma, is seen in acute myocardial infarction, aortic coarctation, acute pulmonary infarction, spontaneous pneumothorax, spontaneous esophageal rupture. (vii) Chest pain with shock, seen in acute myocardial infarction, acute pericardial compression, pulmonary infarction, spontaneous esophageal rupture. In aortic dissection, there may be clinical signs of shock, but the blood pressure is not low, and the electrocardiogram and cardiac enzyme profile are normal. If the tumor ruptures, hemorrhagic shock occurs. (viii) Depending on where the chest pain occurs, it can be helpful in diagnosis. 1, precordial area, seen in angina pectoris, myocardial infarction, pericarditis. 2, retrosternal pain, seen in angina pectoris, acute myocardial infarction, pericarditis, mediastinal disease, esophageal disease. 3.Chest pain on one side, see chest wall, pleura, lung disease. (4) Back pain, in addition to crural disease, aortic coarctation can also occur. (ix) With radiating pain, seen in angina pectoris, acute myocardial infarction, which may radiate to the left shoulder and left arm. And subdiaphragmatic abscess, liver abscess may radiate to the sick side of the chest. And gallbladder disease may radiate to the right back subacromial scapula. (x) Chest pain with associated heart murmur can be seen in mitral valve prolapse, hypertrophic obstructive cardiomyopathy, aortic valve insufficiency and stenosis, aortic coarctation, aortic sinus aneurysm rupture. (xi) Chest pain accompanied by obvious dizziness, palpitations, panic and other neurosis symptoms and objective examination is not obvious found in panic attacks. Chest pain (chestpain) is a common symptom, the clinical significance of which can be large or small, so the first task in the diagnosis of chest pain is to rule out fatal diseases such as acute myocardial infarction, acute pulmonary embolism, aortic coarctation, tension pneumothorax, as well as acute abdomen. For patients with chest pain, it is best to find the cause. I. Diagnostic considerations (a) Medical history 1, the onset of the delay, duration, severity, pain site, nature, with or without radiation. 2, chest pain and whooping, coughing, swallowing, physical activity, emotional excitement has no relationship. Accompanying symptoms: coughing up sputum, hemoptysis, dysphagia, dysphagia, acid reflux, heartburn, palpitation, forced position, fever, edema and so on. 4.Has there been any similar episodes in the past, how to treat, what kind of drugs have been used, how responsive to the drugs. 5.History of chest surgery, history of trauma. 6.With or without cardiovascular disease risk factors. （Physical examination: 1. Any abnormalities of the chest wall and localized tenderness, including skin, ribs and intercostal nerves. 2. 2.Whether there are signs of pathology of the whistle and circulatory system, and if necessary, measure the blood pressure of the limbs. (3) Any deformity, pressure and percussion pain in the crista. (C) Other examinations 1, electrocardiogram, chest X-ray. 2, Echocardiography. 3, Laboratory tests: blood routine, cardiac enzyme spectrum, D-dimer, etc.. 4, Crest X-ray, MRI if necessary. 5.CT examination: including coronary artery CT angiography and CT pulmonary arteriography, etc. 6, Coronary arteriography. 7, digestive system related examination: such as 24-hour esophageal acid measurement, gastroscopy, abdominal plain film, abdominal ultrasound, etc. II. Differential Diagnosis (I) Chest pain caused by chest wall diseases, with clear localization, limitation, and mostly positive localization, such as rashes, redness, swelling, compression pain, and deformity. (ii) Crestal diseases compressing the nerve roots, with stabbing, electric shock and tearing pains, mostly episodic. It may extend to areas away from the irritation. Examination of the crestal column reveals deformity, pressure, and percussion pain, and the pain occurs or worsens when the body is twisted or a heavy object is held. (c) Retrosternal pain associated with swallowing is seen in diseases of the esophagus and mediastinum. If it is accompanied by heartburn and acid reflux, it is a typical clinical manifestation of reflux esophagitis. (d) Chest pain accompanied by cough and aggravated by coughing and deep whistling indicates that the lesion has invaded the pleura, which can be seen in pneumonia, tuberculosis, lung abscess and pleurisy. (E) Chest pain occurs during labor, full meal or emotional excitement, which should be considered as angina pectoris, myocardial infarction or aortic coarctation. (F) Sudden severe chest pain, in addition to trauma, is seen in acute myocardial infarction, aortic coarctation, acute pulmonary infarction, spontaneous pneumothorax, spontaneous esophageal rupture. (vii) Chest pain with shock, seen in acute myocardial infarction, acute pericardial compression, pulmonary infarction, spontaneous esophageal rupture. In aortic dissection, there may be clinical signs of shock, but the blood pressure is not low, and the electrocardiogram and cardiac enzyme profile are normal. If the tumor ruptures, hemorrhagic shock occurs. (viii) Depending on where the chest pain occurs, it can be helpful in diagnosis. 1, precordial area, seen in angina pectoris, myocardial infarction, pericarditis. 2, retrosternal pain, seen in angina pectoris, acute myocardial infarction, pericarditis, mediastinal disease, esophageal disease. 3.Chest pain on one side, see chest wall, pleura, lung disease. (4) Back pain, in addition to crural disease, aortic coarctation can also occur. (ix) With radiating pain, seen in angina pectoris, acute myocardial infarction, which may radiate to the left shoulder and left arm. And subdiaphragmatic abscess, liver abscess may radiate to the sick side of the chest. And gallbladder disease may radiate to the right back subacromial scapula. (x) Chest pain with associated heart murmur can be seen in mitral valve prolapse, hypertrophic obstructive cardiomyopathy, aortic valve insufficiency and stenosis, aortic coarctation, aortic sinus aneurysm rupture. (xi) Chest pain accompanied by obvious dizziness, palpitations, panic and other neurosis symptoms without obvious findings on objective examination is seen in panic attacks.