Tony Kadysewski's List: Chest Pain Descriptions

• often vigorously denies feeling chest "pain." More typical descriptions include squeezing, tightness, pressure, constriction, strangling, burning, heart burn, fullness in the chest, a band-like sensation, knot in the center of the chest, lump in the throat, ache, heavy weight on chest (elephant sitting on chest), like a bra too tight, and toothache (when there is radiation to the lower jaw). In some cases, the patient cannot qualify the nature of the discomfort, but places his or her fist in the center of the chest (the "Levine sign").
  A "sharp" or "stabbing" pain with a pleuritic or positional component that is fully reproducible by palpation, in patients who have no history of angina or myocardial infarction, probably have low-risk for the episode being ischemic.
  

• Aortic dissection. In this condition, the inner layers of the main artery leading from your heart (aorta) separate, forcing blood between them. Symptoms are sudden and tearing chest and back pain.
• Coronary artery spasm. Coronary spasm can cause varying degrees of chest discomfort. In coronary spasm, arteries that supply blood to your heart go into spasm, temporarily closing down blood flow to your heart. It can occur with activity or at rest. A spasm may even wake you from sleep.
• Panic attack. Symptoms of a panic attack include intense fear accompanied by chest pain, rapid heartbeat, rapid breathing (hyperventilation), profuse sweating and shortness of breath.

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• It is not common to equate severity of angina with risk of fatal cardiac events. There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e., there can be severe pain with little or no risk of a heart attack, and a heart attack can occur without pain).
• Worsening ("crescendo") angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped with similar conditions as the acute coronary syndrome). As these may herald myocardial infarction (a heart attack), they require urgent medical attention and are generally treated as a presumed heart attack.
• Apart from chest discomfort, anginal pains may also be experienced in the epigastrium (upper central abdomen), back, neck area, jaw, or shoulders. This is explained by the concept of referred pain, and is due to the spinal level that receives visceral sensation from the heart simultaneously receiving cutaneous sensation from parts of the skin specified by that spinal nerve's dermatome, without an ability to discriminate the two
• Most patients with angina complain of chest discomfort rather than actual pain: the discomfort is usually described as a pressure, heaviness, tightness, squeezing, burning, or choking sensation.
• Typical locations for referred pain are arms (often inner left arm), shoulders, and neck into the jaw.
• Angina is typically precipitated by exertion or emotional stress. It is exacerbated by having a full stomach and by cold temperatures. Pain may be accompanied by breathlessness, sweating and nausea in some cases. It usually lasts for about 3 to 5 minutes, and is relieved by rest or specific anti-angina medication.
• Chest pain lasting only a few seconds is normally not angina.
• Some experience "autonomic symptoms" (related to increased activity of the autonomic nervous system) such as nausea, vomiting and pallor.

• Unstable angina

   

  Unstable angina (UA) is defined as angina pectoris that changes or worsens.^[1]

   

  It has at least one of these three features:

   
   
  1. it occurs at rest (or with minimal exertion), usually lasting >10 min;
   
  2. it is severe and of new onset (i.e., within the prior 4–6 weeks); and/or
   
  3. it occurs with a crescendo pattern (i.e., distinctly more severe, prolonged, or frequent than previously).
   
   

  UA may occur unpredictably at rest which may be a serious indicator of an impending heart attack. What differentiates stable angina from unstable angina (other than symptoms) is the pathophysiology of the atherosclerosis. In stable angina, the developing atheroma is protected with a fibrous cap. This cap (atherosclerotic plaque) may rupture in unstable angina, allowing blood clots to precipitate and further decrease the lumen of the coronary vessel. This explains why an unstable angina appears to be independent of activity.

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