When evaluating chest pain, what should be the first investigation?

In the context of evaluating chest pain, ruling out a cardiac etiology first is crucial because many serious cardiac conditions, such as myocardial infarction or unstable angina, require immediate attention and management. Chest pain is often one of the primary presentations of heart-related issues, and detecting or excluding these conditions quickly can be life-saving.

The systematic approach to chest pain emphasizes the importance of identifying potentially life-threatening cardiac causes before considering other less critical conditions. A thorough history, physical examination, and diagnostic tests like an ECG or cardiac biomarkers (such as troponins) are typically employed in this initial phase to assess heart function and rule out acute coronary syndromes.

In contrast, while gastrointestinal conditions can also cause chest pain, their management typically follows the initial cardiac evaluation. Similarly, renal and neurological causes of pain are generally less urgent than cardiac conditions and can be explored after ruling out any cardiac issues. This prioritization helps ensure that critical interventions are implemented promptly to prevent adverse outcomes.