Chest pain history and symptoms
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
The symptoms of chest pain can help to discern whether there is an underlying cause that may be dangerous. Symptoms that should cause alarm are; chest pain radiating to the back (aortic dissection), left arm or jaw pain, nausea, vomiting, lightheadedness, and anginal pain that is different from baseline (myocardial infarction). Pain that is reproduced with palpation, greatest in the abdominal region, radiating to lower extremities, brought on by inspiration, or brought on my movement or postural changes, is less characteristic of myocardial ischemia.
Symptoms
Chest Pain Suggestive of Cardiac Ischemia as the Underlying Cause
- Describing the pain as heaviness, a pressure or a band like tightness.
- Radiation of the pain to neck, jaw or left arm
- Sweating
- Nausea
- Palpitations
- Pain with exertion
- Dizziness
- Shortness of breath
- A sense of impending doom.
Chest Pain Non-characteristic of Myocardial Ischemia
- Muscular pain; reproduced with or brought on by shoulder and/or forearm movements or postural changes,
- Pleura related pain (pleuritic pain); a sharp or knife-like pain brought on by respiratory movements as deep breathing or cough
- Primary or sole location of discomfort in the middle or lower abdominal region
- Pain that may be localized at the tip of one finger, particularly over the left ventricular apex or a costochondral junction
- Pain reproduced with movement or palpation of the chest wall or arms
- Very brief episodes of pain that last a few seconds or less
- Pain that radiates into the lower extremities
The relief of chest pain by administration of sublingual nitroglycerin in outpatient setting is not diagnostic of coronary artery disease. For instance, esophageal pain can be relieved by administration of nitroglycerin. Likewise, the relief of chest pain by the administration of liquid or chewable antacids and anti reflux drugs does not exclude coronary artery disease as the underlying etiology of the pain.