BackgroundChest pain is one of the common causes of visits to the emergency department. However, there is scarcity of studies on the causes and prevalence of this common symptom in Eritrea. This retrospective descriptive study was done to determine the prevalence, causes, clinical features, demographics, diagnostic modality and outcome of all patients with the chief complaint of chest pain who presented to the ED of Orotta national referral hospital in Eritrea and the association of demographic characters, diagnostic modality, and clinical features with final diagnosis and outcome.MethodsAfter securing approval by Ministry of Health ethical and research committee, Clinical Service Division and from Orotta National Referral Hospital in Asmara Eritrea, Records of patients 15 years and older presenting with the complaint of chest pain from 1st January 2018 through 31st December 2018 were assessed. A sample of patients who presented with chest pain and did ECG were also included. All data were collected in Microsoft excel software, cleaned and then analyzed using Statistical Package of Social Sciences (SPSS) software version 20.Results855 patients presented with chest pain to the emergency department, out of which 798 patient files were retrieved. Respiratory disease was the most common cause 441(51.6%), with pneumonia the most common diagnosis 415 (94.1%) followed by cardiac cause at 234( 27.4%).Out of the study population 253 study sample were taken with inclusion criteria of those who did an ECG. In these study samples the most common cause was cardiovascular 149(58.9%) out of which the most common illness was ST elevation myocardial infarction 60(23.7%). Out of 253 patients who did electrocardiogram 230(90.9%) were discharged and 23(9.1%) died. 6(26%) of those who died were smokers and 13(56.5%) of those who died were above 69 years old.ConclusionThe main cause of chest pain was found to be respiratory disease, followed by cardiovascular disease in the population study, which was reversed in the sample study (those who did ECG). Age and Smoking were found to affect the prognosis. There were highest mortality rates in STEMI and pulmonary embolism.