Cardiac Chest Pain Clinical Presentation

Typical Chest Pain: 3 criteria
1. Substernal discomfort
2. Exertional (emotion, exercise)
3. Alleviated by rest or nitroglycerin
Atypical Chest Pain: 2 criteria
Non-cardiac Chest Pain: <1 criteria

	PP	PN
O	sudden, random
• Stable: at exercise
• Unstable: at rest
P	substernal, central chest or epigastrium, diffused (not pin-pointed)
Q	pressure/heaviness/tightness/burning sensation (x	Stabbing (‣)
R	radiating to the jaw, arms, neck(throat), shoulder
(Upper border: → does not radiate to upper jaw)
(Lower border: → does not radiate to umbilicus)
S	NA
T	lasting for 5-20 min
• Stable: resolved by rest in a few minutes
• Unstable: prolonged	1-2 seconds: MSK, e.g. myochondrocitis

Aggregate	Exertion, eating, emotion, or cold (diversion of blood)
Alleviate	Rest or use of nitroglycerin (vasodiator)
Associated Symptom	‣ , ‣ cold sweat

Pertinent Positive:

Exertional*

Angina - Canadian Cardiovascular Society Angina Grading Scale
Vascular Risk Factors

Pertinent Negative:

Palpitation
can be pin-pointed
reproducible by movement or inspiration
lasting a few seconds or hours

Etiology DDx

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Different Types of CADs

	‣ (Chronic, Vaso-spatic)	‣	‣	‣
Pathophysiology	Stable fixed plaque	Unstable plaque (platelet aggregation)	Thrombus (partial occlusion)
*Doesn’t matter small vs. big vessel	Thrombus (full occlusion)
*Doesn’t matter small vs. big vessel
Cardiac Enzyme (‣) ‣MB	normal/+	normal/+	++	+++
‣	TWI/Normal	STD/TWI/Normal	STD/TWI
‣	STE
‣
‣	Normal	RWMA/normal	RWMA (hypokinesia)/Normal	Regional* Akinesia, Decreased LVEF, Mechanical complications
Functional Test	‣	‣	X	X
Anatomical Test	Non-invasive (‣)	Depends	Invasive
(‣)	Invasive
(‣)
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Valvular Diseases

Aortic Stenosis and Mitral Valve Stenosis/ MR - Mitral Valve Regurgitation → decrease CO → low perfusion of coronary artery