Approach to the adult patient with non--traumatic chest pain in the emergency department

Chest pain is one of the most common reasons for presentation to the emergency department and may be attributable to a wide spectrum of cardiac and non-cardiac etiologies. Given that this clinical manifestation may indicate life-threatening conditions—such as acute coronary syndrome, aortic dissection, pulmonary embolism, pneumothorax, pericardial tamponade, and mediastinitis—a prompt and structured diagnostic approach is essential. Clinical data including history, physical examination findings, vital signs, and prior test results play a pivotal role in risk stratification and guiding the diagnostic algorithm. Electrocardiography, cardiac biomarkers, D-dimer testing, chest radiography, and—when indicated—advanced imaging modalities such as computed tomography, magnetic resonance imaging, and echocardiography, contribute significantly to diagnostic accuracy. This review discusses a systematic approach to adult patients presenting with non-traumatic chest pain in the emergency setting, and summarizes key clinical scenarios and therapeutic strategies in differential diagnosis based on current literature.