Respiratory Chest Pain in Primary Care

Common in GP; most cases non-cardiac, but cardiac cause must be excluded first
Respiratory pain often sharp, pleuritic (↑ with deep breath, cough, sneeze, movement)
Range from benign (e.g. viral pleurisy) → life-threatening (PE, pneumothorax, severe pneumonia)
Always assess ABC, obs, and rule out ACS (acute coronary syndrome) and aortic dissection in parallel.

Typical Respiratory Chest Pain Pattern

Pleuritic pain = pain from pleura / chest wall

Sharp, stabbing, well-localised
Worse with:
- Deep inspiration
- Cough / sneeze
- Movement, lying on affected side
May improve with shallow breathing
Often associated: SOB (shortness of breath), cough, ± fever

Contrast: cardiac ischaemia → classically central, pressure/heavy, may radiate to arm/jaw, often exertional, not pleuritic.

Major Respiratory Causes of Chest Pain

Condition	Pain & Pattern	Key Clues / Typical Context
Viral pleurisy (pleuritis)	Sharp, well-localised pleuritic pain; ↑ with inspiration/cough	Post-viral, mild fever, otherwise well, normal or near-normal CXR; often young/fit adults
Community-acquired pneumonia	Pleuritic pain, often lateral/basal	Fever, cough, sputum, ↑RR, focal crackles; any age, more severe in older/comorbid
Pulmonary embolism (PE) ⚠	Sudden pleuritic chest pain; may be subtle	Acute SOB, tachycardia, haemoptysis or syncope; often normal chest exam; RFs: recent surgery/immobility, pregnancy, OCP/HRT, cancer, prior VTE
Spontaneous...

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