From the Guidelines
Aortic chest pain, also known as Angina Pectoris, typically presents as a pressure, tightness, or heaviness in the chest, often accompanied by shortness of breath, fatigue, or faintness, and may radiate to the arms, back, or jaw. The characteristics of discomfort related to myocardial ischemia (angina pectoris) can be divided into four categories: location, character, duration, and relationship to exertion and other exacerbating or relieving factors 1. 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.
Key Symptoms
- Pressure, tightness, or heaviness in the chest
- Shortness of breath
- Fatigue or faintness
- Pain or discomfort radiating to the arms, back, or jaw
- Duration of discomfort is brief, typically no more than 10 minutes
- Relationship to exercise, specific activities, or emotional stress
Atypical Angina
Atypical angina is most frequently chest pain resembling that of typical angina in location and character, that is responsive to nitrates but has no precipitating factors 1. Often, the pain is described as starting at rest from a low level of intensity, which slowly intensifies, remains at its maximum for up to 15 minutes, and then slowly decreases in intensity. This characteristic description should alert the clinician to the possibility that coronary vasospasm is present.
Importance of Early Recognition
Early recognition of aortic chest pain is crucial, as it can be a symptom of a life-threatening condition such as aortic dissection or aneurysm rupture 1. Therefore, it is essential to seek immediate medical attention if experiencing any of these symptoms, as rapid diagnosis and treatment can significantly improve survival rates.
From the Research
Symptoms of Aortic Chest Pain (Angina Pectoris)
The symptoms of aortic chest pain, also known as Angina Pectoris, can be severe and potentially life-threatening. Some common symptoms include:
- Chest or back pain, which is the most commonly reported presenting symptom of acute aortic syndrome (AAS) 2, 3
- Truncal pain 4
- Syncope (fainting) 4
- Neurologic deficit 4
- Limb ischemia 4
- Severe hypertension 2, 3
- Uncontrollable pain and hypertension 2
- Refractory pain 4
- Severe aortic dilatation, impending or frank rupture, organ malperfusion 4
Clinical Presentation
Patients with aortic chest pain often present with unspecific signs and symptoms, making diagnosis challenging 3, 4. The clinical presentation can vary, but common characteristics include:
- Acute onset of severe chest or back pain
- Pain can be described as tearing, ripping, or stabbing
- Pain can radiate to the back, abdomen, or legs
- Patients are typically aged 60 to 70 years, male, and have hypertension 2
Diagnosis and Management
Diagnosis of aortic chest pain requires prompt and accurate evaluation, including:
- Contrast-enhanced tomography angiography (CTA) of the chest and abdomen 4
- Transesophageal echocardiography 2, 3
- D-dimer testing 2, 4
- Bedside echocardiography 4 Therapeutic management includes medical therapy, such as opioid and anti-impulse drugs, and surgical intervention, including urgent surgery for patients with AAS involving the ascending aorta 4 and endovascular treatment for complicated type B AAS 4.