In a case of chest pain following a cough, what is the recommended next diagnostic step?

In cases of chest pain following a cough, especially when considering the differential diagnoses that may include conditions like pneumonia, pulmonary embolism, or musculoskeletal pain, the electrocardiogram (ECG) is a vital first step in the diagnostic process. The ECG serves as a primary tool in assessing cardiac involvement by ruling out or identifying ischemic changes, arrhythmias, or other cardiac conditions that could present with chest pain.

This choice is particularly crucial in scenarios where there is a possibility of conditions such as a myocardial infarction or unstable angina, particularly since chest pain can sometimes reflect serious cardiovascular issues. An ECG can provide immediate information, allowing appropriate management decisions to be made quickly.

While imaging studies like chest X-ray or CT scans could provide valuable information regarding pulmonary issues or structural anomalies, they are generally not the first-line investigations in the presence of chest pain unless there are specific indicators pointing towards pulmonary or anatomical concerns. A chest ultrasound is typically not utilized in the initial assessment of chest pain unless fluid status or specific pleural or cardiac conditions need evaluation. Thus, the electrocardiogram stands out as the most appropriate initial diagnostic investigation in this scenario.