CHEST PAIN

Problem

Process

Location

Quality

Severity

Timing

Factors that
Aggravate

Factors that
Relieve

Associated
Symptoms

Temporary
myocardial
ischemia, usually
secondary to
coronary
atherosclerosis

Retrosternal, across
the anterior chest,
sometimes
radiating to
shoulders, arms,
neck, lower jaw, or
upper abdomen

Pressing,
squeezing,
tight, heavy,
occasionally
burning

Usually 1-2
min but up to
10 min.
Prolonged
episodes up
to 20 min

Exertion,
especially in
the cold;
meals;
emotional
stress. May
occur at
rest

Rest,
nitroglyceri
n

Sometimes
dyspnea,
nausea,
sweating

Myocardial
Infarction

Prolonged
myocardial
ischemia, resulting
irreversible muscle
damage or necrosis.

Same as angina

Same as in
angina

Mild to
moderate,
sometimes
perceived
as
discomfort
rather than
pain
Often but
not always
with severe
pain

Pericarditis

Irritation of parietal
pleura adjacent ot
pericardium
Mechanism unclear

Precordial may
radiate to the tip of
the shoulder and to
neck

Sharp,
knifelike

Often
severe

Persistent

Breathing,
changing
position,
coughing,
lying down,
sometimes
swallowing

Crushing
Ripping,
tearing

Severe
Very severe

Abrupt onset,
early peak,
persistent for
hours or more

Hypertensio
n

Cardiovascula
r
Angina
Pectoris

Nausea,
vomiting,
sweating,
weakness

Retrosternal
Dissecting
Aortic
Aneurysm

Pulmonary
Tracheobronc
hitis

Pleuritic pain

A splitting within the

layers f the aortic
wall, allowing
passage of blood to
dissect a channel

Anterior chest,
radiating to neck,
back, or abdomen

Inflammation of
trachea and large
bronchi

Upper sternal or on
either side of the
sternum

Burning

Mild to
moderate

Variable

Coughing

Inflammation of
parietal pleura, a in
pleurisy,
pneumonia,

Chest wall overlying

the process

Sharp,
knifelike

Often
severe

Persistent

Inspiration,
coughing,
movements
of the trunk

Sitting
forward
may relieve
it

Of underlying
disease

Syncope,
hemiplegia,
paraplegia

Laying on
the
involved
side may
relieve it

Cough

Of underlying
illness

pulmonary infarction
or neoplasm