Chest pain is a common presenting symptom of disorders that can range from trivial to life-threatening. The character of angina is tight and crushing, while the pain from aortic dissection has a tearing quality. Oesophageal reflux may be described as a burning pain, and peptic acid-related pain tends to be deep and gnawing. The pain from angina and oesophageal reflux may be located retrosternally, and they both can radiate to the jaw or down into the left arm. The pain from pericarditis may be centrally located and radiate to the shoulders (trapezius ridge pain). Pain from aortic dissection often radiates into the back and occasionally into the abdomen (depending on the extent of the dissection). Pulmonary pain can be located anywhere in the thorax. Angina may be precipitated by effort, a defining characteristic. Other known precipitants of angina are emotion, food and cold weather. If angina occurs at rest for more than 20 min, it should be treated as a myocardial infarction until proven otherwise. Oesophageal reflux is often related to meals and precipitated by changes in posture, such as bending or lying. Pain originating from pericarditis and pulmonary origin is often pleuritic, i.e. worse on inspiration; however, musculoskeletal pain can also be worse on breathing due to movement of the thorax. Both oesophageal spasm and angina may be relieved by GTN, which relaxes smooth muscle. Antacids will relieve the pain of oesophageal reflux but not angina. The pain associated with pericarditis may be relieved by sitting forwards.
Chest Pain
History
Character
Location
Precipitating factors
Relieving factors
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