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Table : Clinical and diagnostic features of chest pain

Condition Pain features Physical examination Electrocardiogram Chest x-ray

Stable angina Substernal pressure, tightness, ache, Normal or S4, murmur may be ST depression, T-wave May be normal
heaviness after exertion, lasting 10 present abnormalities
minutes or more, relieved by rest
Unstable angina Substernal pressure or tightness at rest Normal or S4, murmur may be ST depression, T-wave May be normal
lasting 10 to 20 minutes occasionally present abnormalities
relieved by nitroglycerin
Myocardial Substernal pressure or tightness with Normal or S4, murmur may be ST elevations in contiguous May be normal unless
infarction radiation to left or both arms or neck, present, S3 if congestive heart leads with reciprocal changes congestive heart failure is
lasting >30 minutes failure present present
Pericarditis Sharp, pleuritic, in the left precordial area, Pericardial rub Diffuse ST elevations
may last hours or days, relieved by sitting
Aortic dissection Abrupt onset of severe tearing pain Blood pressure differential upper LVH may be present Widened mediastinum
radiating to the back extremities, murmur of aortic
Anxiety/panic Sharp, stabbing, variable length Normal cardiovascular exam Normal Normal
Pneumonia Sharp, sudden onset accompanied by Crackles, egophony Normal Evidence of consolidation
fever, dyspnea
Pulmonary Abrupt onset, accompanied by dyspnea Right ventricle heave, tachycardia, Tachycardia, RVH, RAD May be normal, atelectasis
embolism right-sided S3
Costochondritis Sharp pain, lasting seconds or hours, Chest tenderness may be present Normal Often normal
worsened by palpation or movement
Pneumothorax Abrupt onset, accompanied by dyspnea Absent breath sounds on the Tachycardia Collapsed lung
affected side, hyper resonant to
GERD Burning or epigastric pain, relieved by Normal Normal Normal
antacids or proton pump inhibitors