Medicine and Man

Chest comes in many varieties! For the purpose of developing heart attack there are 3 criteria that need to be considered:

1. Description – Has 2 sub criteria:-
2. 1. Location – Central chest pain with radiation typically to the left shoulder (although radiation may occur to the right shoulder, neck and jaw)
   2. Quality – crushing, band like around chest, heavy as if somebody is sitting on the chest
3. Precipitating factors – Classically precipitated by activity which is reproducible (i.e. walking 2 blocks every time will result in chest pain)
4. Relieving factors – The pain is relieved by rest or nitroglycerin (the pain goes away within 5-10 minutes after taking nitroglycerin, if it takes longer, pain relief is not due to nitroglycerin and will not be considered a relieving factor)

(Picture taken from Home Emergency Preparedness)

Based on these three variables chest pain can be classified into 3 types:

1. Classical (anginal) – Chest pain meeting all the above criteria i.e. appropriate description along with precipitating and relieving factors. These people are at a very high risk of developing heart attacks.
2. Atypical – Chest pain with any one of the above variables (appropriate description or precipitating or relieving factors) is atypical and these people are at moderate risk of heart attacks.
3. Non anginal – Chest pain that does not match any of the above criteria. These people are at low risk of heart attacks.

Comments:

• Classical (anginal) chest pain should never be ignored and medical help should be sought immediately
• Atypical chest pain should in most cases (in the right clinical scenario) be evaluated by a cardiac stress test.
• Non-anginal chest pain should also be evaluated by a doctor as it may indicate some other disease that my be serious!

Bottom line: Chest pain should be evaluated in all cases. The type of chest pain will determine the urgency of the situation.

Tags: Atherosclerosis, Heart Attack, Myocardial Infarction, Review

This entry was posted on Sunday, September 7th, 2008 at 2:15 pm and is filed under Review. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.