What are the symptoms of acute chest pain (Angina Pectoris)?

From the Guidelines

Acute chest pain, also known as Angina Pectoris, can manifest with various symptoms including pain, pressure, tightness, or discomfort in the chest, shoulders, arms, neck, back, upper abdomen, or jaw, as well as shortness of breath and fatigue, and patients should seek medical care immediately if they experience any of these symptoms. The symptoms of acute chest pain can vary depending on the underlying cause, but the most common symptom is pain or discomfort in the chest that may feel like pressure, squeezing, fullness, or burning 1. This pain can radiate to the jaw, neck, back, shoulders, or arms, particularly the left arm. Other symptoms include shortness of breath, cold sweats, nausea, vomiting, dizziness, lightheadedness, and anxiety. Some patients may experience palpitations or an irregular heartbeat.

Key Characteristics of Angina Pectoris

• The discomfort caused by myocardial ischemia is usually located in the chest, near the sternum, but may be felt anywhere from the epigastrium to the lower jaw or teeth, between the shoulder blades or in either arm to the wrist and fingers 1.
• The discomfort is often described as pressure, tightness or heaviness; sometimes strangling, constricting or burning.
• Shortness of breath may accompany angina, and chest discomfort may also be accompanied by less-specific symptoms such as fatigue or faintness, nausea, burning, restlessness or a sense of impending doom.
• The duration of the discomfort is brief—no more than 10 min in the majority of cases and more commonly even minutes or less—but chest pain lasting for seconds is unlikely to be due to angina.

Importance of Seeking Medical Attention

• Patients with acute chest pain or chest pain equivalent symptoms should seek medical care immediately by calling 9-1-1, as the evaluation of all patients should focus on the early identification or exclusion of life-threatening causes 1.
• High-sensitivity cardiac troponins are the preferred standard for establishing a biomarker diagnosis of acute myocardial infarction, allowing for more accurate detection and exclusion of myocardial injury 1.
• The clinical presentation of acute coronary syndromes (ACS) is broad, and the leading symptom initiating the diagnostic and therapeutic cascade in patients with suspected ACS is acute chest discomfort described as pain, pressure, tightness, and burning 1.

From the FDA Drug Label

Angina is a pain or discomfort that keeps coming back when part of your heart does not get enough blood Angina feels like a pressing or squeezing pain, usually in your chest under the breastbone. Sometimes you can feel it in your shoulders, arms, neck, jaws, or back.

The symptoms of acute chest pain (Angina Pectoris) are:

• A pressing or squeezing pain, usually in the chest under the breastbone
• Pain or discomfort that keeps coming back when part of the heart does not get enough blood
• Pain may also be felt in the:
  • Shoulders
  • Arms
  • Neck
  • Jaws
  • Back 2

From the Research

Symptoms of Acute Chest Pain (Angina Pectoris)

The symptoms of acute chest pain, also known as Angina Pectoris, can vary depending on the underlying cause. Some common symptoms include:

• Pressure, fullness, burning, squeezing, or tightness in the chest 3
• Discomfort in the shoulders, arms, neck, jaw, or back 3
• Pain that radiates to one or both arms 3
• Atypical chest pain, such as dyspnea, weakness, and fatigue, especially in women 3

Cardiac and Non-Cardiac Causes

Acute chest pain can be caused by cardiac or non-cardiac conditions. Cardiac causes of chest pain usually have anginal symptoms, while non-cardiac causes have a variety of chest pain characteristics 4. Some life-threatening conditions that require immediate attention and intervention include:

• Myocardial infarction/unstable angina 4
• Dissecting aortic aneurysm 4
• Pericarditis 4
• Pulmonary embolism 4
• Pneumothorax 4
• Pneumonia 4
• Acute chest syndrome 4

Diagnostic Approach

A thorough history and physical examination, as well as the 12-lead ECG and laboratory tests, are crucial in diagnosing the cause of acute chest pain 5. It is also important to distinguish between cardiac chest pain and other forms of chest pain to treat patients appropriately and exclude potentially life-threatening conditions 5. Radiologists should be aware of the differential diagnosis of acute chest pain and use chest CT examinations to suggest alternative diagnoses 6.