Chest pain classification: Difference between revisions
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*Sharp [[chest pain]] that increases with [[inspiration]] and lying [[supine]] usually occur with acute [[pericarditis]] and is unlikely related to [[ischemic heart disease]] | *Sharp [[chest pain]] that increases with [[inspiration]] and lying [[supine]] usually occur with acute [[pericarditis]] and is unlikely related to [[ischemic heart disease]] | ||
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|Onset and [[duration]] | |style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Onset and [[duration]] | ||
*[[Anginal symptoms]] gradually increase in intensity over a few minutes | *[[Anginal symptoms]] gradually increase in intensity over a few minutes | ||
*Sudden onset of ripping [[chest pain]] (with radiation to the upper or lower [[back]]) is suspicious of an acute [[aortic syndrome]] and is unlikely to be [[anginal]]. | *Sudden onset of ripping [[chest pain]] (with radiation to the upper or lower [[back]]) is suspicious of an acute [[aortic syndrome]] and is unlikely to be [[anginal]]. | ||
*Fleeting [[chest pain]]—of few seconds’ duration—is unlikely to be related to [[ischemic heart disease]]. | *Fleeting [[chest pain]]—of few seconds’ duration—is unlikely to be related to [[ischemic heart disease]]. | ||
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|[[Location]] and [[radiation]] | |style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Location]] and [[radiation]] | ||
*[[Pain]] that can be localized to a very limited area and pain radiating to below the [[umbilicus]] or [[hip]] are unlikely related to [[myocardial ischemia]]. | *[[Pain]] that can be localized to a very limited area and pain radiating to below the [[umbilicus]] or [[hip]] are unlikely related to [[myocardial ischemia]]. | ||
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|[[Severity]] | |style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Severity]] | ||
*Ripping [[chest pain]] (worse [[chest pain]] of my life), especially when sudden in onset and occurring in a [[hypertensive]] [[patient]], or with a known [[bicuspid aortic valve]] or [[aortic dilation]], is suspicious of an [[acute aortic syndrome]] ( [[aortic dissection]]) | *Ripping [[chest pain]] (worse [[chest pain]] of my life), especially when sudden in onset and occurring in a [[hypertensive]] [[patient]], or with a known [[bicuspid aortic valve]] or [[aortic dilation]], is suspicious of an [[acute aortic syndrome]] ( [[aortic dissection]]) | ||
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|[[Precipitating]] factors | |style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Precipitating]] factors | ||
*[[Physical exercise]] or [[emotional stress]] are Common triggers of [[anginal]] [[symptoms]] | *[[Physical exercise]] or [[emotional stress]] are Common triggers of [[anginal]] [[symptoms]] | ||
*Occurrence at [[rest]] or with minimal [[exertion]] associated with [[anginal symptoms]] usually aoociated with [[ACS]] | *Occurrence at [[rest]] or with minimal [[exertion]] associated with [[anginal symptoms]] usually aoociated with [[ACS]] | ||
*[[Positional]] [[ chest pain]] usually indicates [[nonischemic]] ([[ musculoskeletal]]) | *[[Positional]] [[ chest pain]] usually indicates [[nonischemic]] ([[ musculoskeletal]]) | ||
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|[[Relieving]] factors | |style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Relieving]] factors | ||
*Relief with [[nitroglycerin]] is not necessarily diagnostic of [[myocardial ischemia]] and should not be used as a diagnostic [[criterion]]. | *Relief with [[nitroglycerin]] is not necessarily diagnostic of [[myocardial ischemia]] and should not be used as a diagnostic [[criterion]]. | ||
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|Associated [[symptoms]] | |style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Associated [[symptoms]] | ||
*Common [[symptoms]] associated with [[myocardial ischemia]] including [[dyspnea]], [[palpitations]], [[diaphoresis]], [[lightheadedness]], [[presyncope]] or [[syncope]], upper [[abdominal pain]], or [[heartburn]] unrelated to [[meals]] and [[nausea]] or [[vomiting]] | *Common [[symptoms]] associated with [[myocardial ischemia]] including [[dyspnea]], [[palpitations]], [[diaphoresis]], [[lightheadedness]], [[presyncope]] or [[syncope]], upper [[abdominal pain]], or [[heartburn]] unrelated to [[meals]] and [[nausea]] or [[vomiting]] | ||
*[[Symptoms]] on the left or right side of the [[chest]], [[stabbing]], sharp [[pain]], or [[discomfort]] in the [[throat]] or [[abdomen]] may occur in [[patients]] with [[diabetes]], [[women]], and [[elderly]] [[patients]]. | *[[Symptoms]] on the left or right side of the [[chest]], [[stabbing]], sharp [[pain]], or [[discomfort]] in the [[throat]] or [[abdomen]] may occur in [[patients]] with [[diabetes]], [[women]], and [[elderly]] [[patients]]. | ||
Revision as of 13:44, 19 December 2021
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Chest pain classification On the Web |
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Risk calculators and risk factors for Chest pain classification |
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
Chest pain traditionally has been classified into typical and atypical types. Chest pain that is more likely associated with ischemia consists of substernal chest discomfort aggravated by exertion or emotional stress and relieved by rest or nitroglycerin. The classic description of chest discomfort is based on quality, location, radiation, and provoking and relieving factors, is more likely to be of cardiac ischemic origin. Using the term of atypical chest pain is problematic. Although it was intended to address angina without typical chest symptoms, it is more often used to state that the symptom is noncardiac in origin. Then, it is discouraged the use of atypical chest pain. Notably, chest pain is broadly defined to also include referred pain in the shoulders, arms, jaw, neck, and upper abdomen. So, using the terms of cardiac, possible cardiac, and noncardiac to describe the suspected causes of chest pain are encouraged.
Classification
- Chest pain is classified into three subgroups including cardiac , possible cardiac, and noncardiac etiology.
- Non-cardiac chest pain is used when the etiology of chest pain is not related to heart.
- The term of Non-cardiac chest pain is encouraged to use instead of atypical chest pain, because atypical chest pain is a misleading description
- Cardiac chest Pain means more Than Pain in the Chest.
- Pain, pressure, tightness, or discomfort in the chest, shoulders, arms, neck, back, upper abdomen, or jaw, as well as shortness of breath and fatigue, should all be considered anginal equivalents.
| Chest pain characteristics and corresponding causes |
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Nature
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Onset and duration
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Location and radiation
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Severity
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Precipitating factors
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Relieving factors
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Associated symptoms
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| The above table adopted from 2021 AHA/ACC/ASE Guideline[1] |
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References
- ↑ 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).