From the Guidelines
Typical chest pain is characterized by discomfort, pressure, heaviness, tightness, or pain in the chest that occurs when the heart muscle doesn't receive enough oxygen-rich blood, typically triggered by physical exertion, emotional stress, heavy meals, or exposure to cold temperatures, and relieved by rest or nitroglycerin medication, as described in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1.
Key Characteristics of Typical Chest Pain
- Discomfort, pressure, heaviness, tightness, or pain in the chest
- Triggered by physical exertion, emotional stress, heavy meals, or exposure to cold temperatures
- Relieved by rest or nitroglycerin medication
- Episodes typically last 3-5 minutes
- May radiate to the left arm, neck, jaw, or back
Importance of Recognizing Typical Chest Pain
Recognizing typical chest pain is crucial as it often indicates underlying coronary artery disease and may precede a heart attack, as noted in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline 1.
Diagnosis and Treatment
A careful history and physical examination are essential for diagnosing typical chest pain, and may be supplemented by objective tests such as electrocardiography (ECG) or coronary angiography, as recommended in the 2013 ESC guidelines on the management of stable coronary artery disease 1.
Patient Education
Anyone experiencing new or worsening chest pain should seek immediate medical attention to determine the cause and appropriate treatment, as emphasized in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline 1. Some key points to consider when evaluating chest pain include:
- The characteristics of the pain, such as location, quality, and duration
- The presence of precipitating or relieving factors, such as exertion or rest
- The patient's medical history and risk factors for coronary artery disease
- The results of diagnostic tests, such as ECG or coronary angiography, as discussed in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline 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. Typical chest pain, in the context of angina, is described as a:
- Pressing or squeezing pain
- Usually felt in the chest under the breastbone
- May also be felt in the shoulders, arms, neck, jaws, or back 2
From the Research
Typical Chest Pain Characteristics
- Typical chest pain is often described as chest pressure, tightness, or a squeezing sensation 3
- It is the most frequent symptom in patients presenting with acute myocardial infarction 3
Presentation of Chest Pain
- Chest pain can be a symptom of acute coronary syndrome (ACS) 4, 5, 6, 7
- The diagnosis of acute myocardial infarction is often based on typical changes on a surface electrocardiogram and on changes in cardiac biomarkers 3
Variations in Chest Pain Symptoms
- There is a need to better recognize and understand the impact of sex on symptoms among patients presenting with acute coronary syndrome or acute myocardial infarction 3
- Potential mechanisms for variation in ischemic symptoms by sex are discussed in recent publications 3
Management of Chest Pain
- Medical therapies for ACS include statins, angiotensin-converting enzyme inhibitors, beta blockers, nitroglycerin, and morphine (to relieve chest pain), and oxygen 4
- A novel mnemonic, 'THROMBINS2' (thienopyridines, heparin/enoxaparin, renin-angiotensin system blockers, oxygen, morphine, beta blocker, intervention, nitroglycerin, statin/salicylate), can help bedside clinicians recall all the elements of contemporary ACS management 7