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There is little correlation between the severity of chest pain and the seriousness of its cause. The range of disorders that cause chest discomfort is shown in Table 33-1.
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POTENTIALLY SERIOUS CAUSES
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The differential diagnosis of chest pain is shown in Figs. 33-1 and 33-2. It is useful to characterize the chest pain as (1) new, acute, and ongoing; (2) recurrent, episodic; and (3) persistent, e.g., for hours or days at a time.
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Myocardial Ischemia: Angina Pectoris
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Substernal pressure, squeezing, constriction, with radiation often to left arm; usually on exertion, especially after meals or with emotional arousal. Characteristically relieved by rest and nitroglycerin.
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Acute Myocardial Infarction or Unstable Angina
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Similar to angina but more severe, of longer duration (≥30 min), and not immediately relieved by rest or nitroglycerin (Chaps. 121 and 122). S3 and/or S4 may be present.
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May be substernal or lateral, pleuritic in nature, and associated with hemoptysis, tachycardia, and hypoxemia (Chap. 135).
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Thoracic Aortic Aneurysm
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May impinge on neighboring structures and cause deep, persistent chest pain, dysphagia, hoarseness, or cough (Chap. 127).
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Very severe, in center of chest, a sharp “ripping” quality, radiates to back, not affected by changes in position (Chap. 127). May be associated with weak or absent peripheral pulses.
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Sharp, intense, localized to substernal region; often associated with audible crepitus.
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Usually steady, crushing, substernal; often has pleuritic ...