Acute chest, epigastric, back, neck, shoulder pain is very common, perhaps a person’s whole life to experience at least one of these more than one kind of pain, I have had a transient chest pain and back pain experience, in general the problem is not too big, but the symptoms to be sustained or more intense it is not good to say, of course, there are exceptions to the rule, 10 days ago in the emergency department encountered a 60 year old woman, epigastric discomfort (not to say that it is difficult to say that it does not hurt! ) more than 3 hours, electrocardiogram shows mild ischemic changes in the myocardium (there are several leads T-wave flattening), myocardial enzymes, blood amylase, ultrasound are all fine, because it is a nurse’s relative, cardiology doctor is more careful, said that do not worry about hospitalization and observation. As a result, he was hospitalized at 11:00 p.m. and died at 5:00 a.m. of sudden cardiac arrest. Then there was the patient with acute back pain I mentioned in my last post, which turned out to be an aortic dissection, which is usually preceded by chest pain, and then possibly back, abdominal, and neck pain. To be honest, according to the book of diagnostic criteria to consider the patient, at least more than 50% misdiagnosis, so sick to the hospital, the doctor asked a few words on the bill, the patient is very angry, saying that the doctor is too bad no level, our patients are always “being examined”, I do not know that the doctor is also helpless, the following examples, such as an acute chest or abdomen or back or neck or shoulder pain, may be the diagnosis of the disease, the patient may have chest pain first, and then there may be back or neck pain. Shoulder pain, possible disease diagnosis. 1, acute myocardial infarction; 2, aortic coarctation; 3, hypertrophic cardiomyopathy; 4, acute pericarditis; 5, angina pectoris; 6, pulmonary embolism; 7, pneumothorax; 8, pneumonia; 9, pleurisy; 10, costal chondritis; 11, herpes zoster; 12, spinal cord hemorrhage; 13, thoracolumbar vertebral fracture; 14, acute obstructive purulent cholangitis; 15, acute pancreatitis; 16, acute cholecystitis; 17, acute gastritis; 18, acute cholecystitis; 17, acute cholecystolysis. Acute gastritis; 18, Reflux esophagitis; Note: Diseases in bold are prioritized as potentially fatal.