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{{Chest pain}}
{{Chest pain}}


{{CMG}}; {{AE}}{{Aisha}}  
{{CMG}}; {{AE}} {{Sara.Zand}} {{Aisha}}  


==Overview==
==Overview==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
[[Angina pectoris]] is defined as a retrosternal [[chest discomfort]] that increases gradually in intensity (over several [[minutes]]). Percipitant factors are [[physical]] or [[emotional]] [[stress]]. In [[ACS]], [[chest pain]] may occur during [[rest]]. [[Chest pain]] is characterized by [[radiation]] ([[ left arm]], [[neck]], [[jaw]]) and its associated [[symptoms]] ([[ dyspnea]], [[nausea]], [[lightheadedness]]). When actively treated or spontaneously resolving, it disappears over a few [[minutes]]. Relief with [[nitroglycerin]] is not necessarily a diagnostic criterion of [[myocardial ischemia]], especially because other causes such as [[esophageal spasm]] may have respons to [[nitroglycerin]]. Associated [[symptoms]] such as [[shortness of breath]], [[nausea]] or [[vomiting]], [[lightheadedness]], [[confusion]], [[presyncope]] or [[syncope]], or [[vague]] [[abdominal]] symptoms are more frequently seen among [[patient]]s with [[diabetes]], [[women]], and the [[elderly]]. A detailed assessment of [[cardiovascular]] [[risk factors]], review of [[systems]], [[past medical history]], and [[family]] and [[social history]] are ncessary in [[patients]] with [[chest pain]]. It is pivotal to identify and triage the [[patients]] presented with [[chest pain]] within 10 minutes of arrival to the [[hospital]]. [[Patients]] diagnosed with [[STEMI]] should be scheduled for primary [[PCI]]. Early recognition of [[STEMI]] may improve [[outcomes]]. [[Stable angina]] and non-cardiac [[chest pain]] should be evaluated in [[outpaient]] setting.
Common [[complications]] of [[chest pain]] include [[arrythmia]], [[heart failure]] and Death. Depending on the etiology at the time of presentation, the [[prognosis]] may vary. However, the [[prognosis]] is generally regarded as good.


OR
==[[Natural history, Complications, and Prognosis]]==
*[[Angina pectoris]] is defined as a retrosternal [[chest discomfort]] that increases gradually in intensity (over several [[minutes]]).<ref name="pmid34709879">{{cite journal |vauthors=Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ |title=2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=144 |issue=22 |pages=e368–e454 |date=November 2021 |pmid=34709879 |doi=10.1161/CIR.0000000000001029 |url=}}</ref>
* Percipitant factors are [[physical]] or [[emotional]] [[stress]].
*In [[ACS]], [[chest pain]] may occur during [[rest]].
* [[Chest pain]] is characterized by [[radiation]] ([[ left arm]], [[neck]], [[jaw]]) and its associated [[symptoms]] ([[ dyspnea]], [[nausea]], [[lightheadedness]]).
*When actively treated or spontaneously resolving, it disappears over a few [[minutes]].
* Relief with [[nitroglycerin]] is not necessarily a diagnostic criterion of [[myocardial ischemia]], especially because other causes such as [[esophageal spasm]] may have respons to [[nitroglycerin]].
*Associated [[symptoms]] such as [[shortness of breath]], [[nausea]] or [[vomiting]], [[lightheadedness]], [[confusion]], [[presyncope]] or [[syncope]], or [[vague]] [[abdominal]] symptoms are more frequently seen among [[patient]]s with [[diabetes]], [[women]], and the [[elderly]].
*A detailed assessment of [[cardiovascular]] [[risk factors]], review of [[systems]], [[past medical history]], and [[family]] and [[social history]] should be done in [[patients]] with [[chest pain]].
*It is pivotal to identify and triage the [[patients]] presented with [[chest pain]] within 10 minutes of arrival to the [[hospital]].
* [[Patients]] diagnosed with [[STEMI]] should be scheduled for primary [[PCI]].
* Early recognition of [[STEMI]] may improve [[outcomes]].
* [[Stable angina]] and non-cardiac [[chest pain]] should be evaluated in [[outpaient]] setting.
===Complications===
*Common [[complications]] associated with lifethereatening causes of [[chest pain]] include:
**[[Arrythmia]] in the setting of [[ACS]], [[PTE]]
**[[Heart failure]] in the setting of [[STEMI]], [[NSTE-ACS]], [[aortic dissection]]
**[[ Cardiac arrest]] in the setting of massive [[PTE]], [[aorta dissection]], acute [[MI]]


Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
===Prognosis===
 
*[[Prognosis]] is generally good. <ref name="pmid29275346">{{cite journal |vauthors=Ilangkovan N, Mickley H, Diederichsen A, Lassen A, Sørensen TL, Sheta HM, Stæhr PB, Mogensen CB |title=Clinical features and prognosis of patients with acute non-specific chest pain in emergency and cardiology departments after the introduction of high-sensitivity troponins: a prospective cohort study |journal=BMJ Open |volume=7 |issue=12 |pages=e018636 |date=December 2017 |pmid=29275346 |pmc=5770919 |doi=10.1136/bmjopen-2017-018636 |url=}}</ref>. However, depending on the etiology at the time of presentation, the [[prognosis]] may vary.
OR


Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Clinical practice guidelines by the AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guide evaluation based on an objective assessment of prognosis<ref name="pmid34709879">{{cite journal| author=Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK | display-authors=etal| title=2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2021 | volume= 144 | issue= 22 | pages= e368-e454 | pmid=34709879 | doi=10.1161/CIR.0000000000001029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34709879  }} </ref>.
==Natural History, Complications, and Prognosis==


===Natural History===
The [https://www.mdcalc.com/calc/1752/heart-score-major-cardiac-events Heart score] may reduce unnecessary hospital admissions<ref name="pmid28437795">{{cite journal| author=Poldervaart JM, Reitsma JB, Backus BE, Koffijberg H, Veldkamp RF, Ten Haaf ME | display-authors=etal| title=Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department: A Stepped-Wedge, Cluster Randomized Trial. | journal=Ann Intern Med | year= 2017 | volume= 166 | issue= 10 | pages= 689-697 | pmid=28437795 | doi=10.7326/M16-1600 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28437795  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=28806803 Review in: Ann Intern Med. 2017 Aug 15;167(4):JC22] </ref><ref name="pmid30571347">Mahler SA, Lenoir KM, Wells BJ, Burke GL, Duncan PW, Case LD | display-authors=etal (2018) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=30571347 Safely Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge.] ''Circulation'' 138 (22):2456-2468. [http://dx.doi.org/10.1161/CIRCULATIONAHA.118.036528 DOI:10.1161/CIRCULATIONAHA.118.036528] PMID: [https://pubmed.gov/30571347 30571347]</ref>.
*The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.  
*The symptoms of (disease name) typically develop ___ years after exposure to ___.  
*If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
 
===Complications===
*Common complications of chest pain include:
** Arrythmia
** Heart failure
** Death
 
===Prognosis===
*Prognosis is generally good, 1-year mortality rate of patients presenting with chest pain is approximately 0.7%<ref name="pmid29275346">{{cite journal |vauthors=Ilangkovan N, Mickley H, Diederichsen A, Lassen A, Sørensen TL, Sheta HM, Stæhr PB, Mogensen CB |title=Clinical features and prognosis of patients with acute non-specific chest pain in emergency and cardiology departments after the introduction of high-sensitivity troponins: a prospective cohort study |journal=BMJ Open |volume=7 |issue=12 |pages=e018636 |date=December 2017 |pmid=29275346 |pmc=5770919 |doi=10.1136/bmjopen-2017-018636 |url=}}</ref>.
*Depending on the etiology at the time of presentation, the prognosis may vary. However, the prognosis is generally regarded as good.
*The presence of aortic dissection is associated with a particularly poor prognosis among patients presenting with chest pain with a 1-year mortality rate of 90%<ref name="urlAortic Dissection - Cardiovascular Disorders - MSD Manual Professional Edition">{{cite web |url=+https://www.msdmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/aortic-dissection#:~:text=About%2020%25%20of%20patients%20with%20aortic%20dissection%20die%20before%20reaching,dissection%20and%2010%25%20for%20distal. |title=Aortic Dissection - Cardiovascular Disorders - MSD Manual Professional Edition |format= |work= |accessdate=}}</ref>.
*The 1-year mortality rate of patients with non-cardiac chest pain was found to be 2.3% compared with 7.2% in patients presenting with cardiac chest pain<ref name="urlNon-cardiac chest pain: prognosis and secondary healthcare utilisation | Open Heart">{{cite web |url=https://openheart.bmj.com/content/5/2/e000859#:~:text=Results%20More%20than%2060%25%20of,respectively%20(p%3D0.026). |title=Non-cardiac chest pain: prognosis and secondary healthcare utilisation &#124; Open Heart |format= |work= |accessdate=}}</ref>.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{WH}}
<br />
{{WS}}
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]

Latest revision as of 19:16, 17 May 2023

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3]

Overview

Angina pectoris is defined as a retrosternal chest discomfort that increases gradually in intensity (over several minutes). Percipitant factors are physical or emotional stress. In ACS, chest pain may occur during rest. Chest pain is characterized by radiation (left arm, neck, jaw) and its associated symptoms (dyspnea, nausea, lightheadedness). When actively treated or spontaneously resolving, it disappears over a few minutes. Relief with nitroglycerin is not necessarily a diagnostic criterion of myocardial ischemia, especially because other causes such as esophageal spasm may have respons to nitroglycerin. Associated symptoms such as shortness of breath, nausea or vomiting, lightheadedness, confusion, presyncope or syncope, or vague abdominal symptoms are more frequently seen among patients with diabetes, women, and the elderly. A detailed assessment of cardiovascular risk factors, review of systems, past medical history, and family and social history are ncessary in patients with chest pain. It is pivotal to identify and triage the patients presented with chest pain within 10 minutes of arrival to the hospital. Patients diagnosed with STEMI should be scheduled for primary PCI. Early recognition of STEMI may improve outcomes. Stable angina and non-cardiac chest pain should be evaluated in outpaient setting. Common complications of chest pain include arrythmia, heart failure and Death. Depending on the etiology at the time of presentation, the prognosis may vary. However, the prognosis is generally regarded as good.

Natural history, Complications, and Prognosis

Complications

Prognosis

  • Prognosis is generally good. [2]. However, depending on the etiology at the time of presentation, the prognosis may vary.

Clinical practice guidelines by the AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guide evaluation based on an objective assessment of prognosis[1].

The Heart score may reduce unnecessary hospital admissions[3][4].

References

  1. ↑ 1.0 1.1 Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ (November 2021). "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. PMID 34709879 Check |pmid= value (help).
  2. ↑ Ilangkovan N, Mickley H, Diederichsen A, Lassen A, Sørensen TL, Sheta HM, Stæhr PB, Mogensen CB (December 2017). "Clinical features and prognosis of patients with acute non-specific chest pain in emergency and cardiology departments after the introduction of high-sensitivity troponins: a prospective cohort study". BMJ Open. 7 (12): e018636. doi:10.1136/bmjopen-2017-018636. PMC 5770919. PMID 29275346.
  3. ↑ Poldervaart JM, Reitsma JB, Backus BE, Koffijberg H, Veldkamp RF, Ten Haaf ME; et al. (2017). "Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department: A Stepped-Wedge, Cluster Randomized Trial". Ann Intern Med. 166 (10): 689–697. doi:10.7326/M16-1600. PMID 28437795. Review in: Ann Intern Med. 2017 Aug 15;167(4):JC22
  4. ↑ Mahler SA, Lenoir KM, Wells BJ, Burke GL, Duncan PW, Case LD | display-authors=etal (2018) Safely Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge. Circulation 138 (22):2456-2468. DOI:10.1161/CIRCULATIONAHA.118.036528 PMID: 30571347


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