Differential diagnosis
1. ACS (NSTEMI/STEMI/USA)-typical vs atypical ( retrosternal pain, on exertion, resolved with rest or NTG), tender vs producible
2. PE -pleuritic chest pain worsened by deep breathing
3. Dissection -radiating back pain, left and right upper arm BP difference
4. Pericarditis -positional better with leaning forward
5. Pneumothorax -lung sound 
6. Tamponade
Workup
TIMIscore/ heart score
Troponin 0-2-2-4hrs.
EKG
CXR
ASA
NTG and prn
Morphine prn
Heparin drip per pharmacy dose
Lisinopril 2.5
Metoprolol 25
Atorvastatin 80
Pepcid
A1c, lipid, (TSH)
NPO
Echo/ Cardiac cath
cardiology consult