Chest pain is probably the most important symptom of cardiac disease. It is not, however, pathognomonic for heart disease. It is well known that chest pain may result from pulmonary, intestinal, gallbladder, and musculoskeletal disorders. Ask the following questions of any patients complaining of chest pain:
''Where is the pain?'' ''How long have you had the pain?'' ' 'Do you have recurrent episodes of pain?'' ''What is the duration of the pain?'' ''How often do you get the pain?'' ''What do you do to make it better?''
''What makes the pain worse? breathing? lying flat? moving your arms or neck?''
''How would you describe the pain:* burning? pressing? crushing? dull? aching? throbbing? knifelike? sharp? constricting? sticking?''
''Does the pain occur at rest? with exertion? after eating? when moving your arms? with emotional strain? while sleeping? during sexual intercourse?''
''Is the pain associated with shortness of breath? palpitations? nausea or vomiting? coughing? fever? coughing up blood? leg pain?''
Angina pectoris is the true symptom of CHD. Angina is commonly the consequence of hypoxia of the myocardium resulting from an imbalance of coronary supply and myocardial demand. Table 14-1 lists the characteristics that differentiate angina pectoris from the other types of chest pain.
Commonly, a patient may describe the angina by clenching the fist and placing it over the sternum. This is a pathognomonic sign of angina commonly referred to as Levine's sign. Figure 14-10 demonstrates this body language.
When chest pain is related to a cardiac cause, coronary atherosclerosis and aortic valvular disease are the most common ones. Table 14-2 lists some common causes of chest pain.
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