{"id":5119,"date":"2010-08-28T12:25:17","date_gmt":"2010-08-28T12:25:17","guid":{"rendered":"http:\/\/cardiophile.org\/?p=5119"},"modified":"2023-10-24T19:34:43","modified_gmt":"2023-10-24T14:04:43","slug":"evaluation-and-management-of-chest-pain","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/","title":{"rendered":"Evaluation of Chest Pain Focusing on Angina"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/9U0Zj7xuB4Q?si=Qh6zecQTEai6xwfH\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n<h2><span style=\"color: #008000;\">Evaluation of Chest Pain Focusing on Angina<\/span><\/h2>\n<p><span style=\"color: #0000ff;\"><strong>Important differential diagnoses of chest pain in an adult are:<\/strong><\/span><\/p>\n<p>Angina pectoris\/myocardial infarction<br \/>\nPericarditis<br \/>\nAortic dissection<br \/>\nPleurisy<br \/>\nPneumothorax<br \/>\nEsophageal spasm\/oesophagitis<br \/>\nMusculoskeletal\/Costochondritis<br \/>\nBornholm disease also known as Devil&#8217;s grip and epidemic pleurodynia<\/p>\n<p><span style=\"color: #0000ff;\"><strong>Acute coronary syndromes<\/strong><\/span><\/p>\n<p><em><strong>Unstable angina<\/strong><\/em><\/p>\n<p>Angina at rest or lowering of threshold for pre-existing effort angina<\/p>\n<p><em><strong>NSTEMI (Non ST elevation myocardial infarction)<\/strong><\/em><\/p>\n<p>Anginal pain at rest, associated with ECG changes, typically ST segment depression and T wave inversion, if troponin is elevated, it qualifies for the diagnosis of NSTEMI<\/p>\n<p><strong><em>STEMI (ST elevation myocardial infarction)<\/em><\/strong><\/p>\n<p>Similar to NSTEMI, but with ST elevation on ECG, qualifies for primary angioplasty if feasible or thrombolytic therapy if not contraindicated.<\/p>\n<p>Evaluate the nature of the symptoms, history of ischaemic heart disease \u2013 patients with prior history are more at risk of further episodes. Male gender, advancing age and family history of coronary artery disease are non-modifiable risk factors. Traditional cardiac risk factors are diabetes mellitus, hypertension, dyslipidaemia and smoking. Lifestyle factors like obesity, lack of exercise, poor diet and stress also contribute.<\/p>\n<p><span style=\"color: #0000ff;\"><strong>Evaluation of angina<\/strong><\/span><\/p>\n<p>History is the key<br \/>\nUsually there are no physical signs<br \/>\nECG\u00a0 may be normal most of the time<br \/>\nBlood pressure and BMI have to be recorded<br \/>\nLook for murmurs, especially an ejection systolic murmur of aortic stenosis which can cause effort angina<br \/>\nEvidence of peripheral vascular disease and carotid bruits have to be sought as these would suggest more severe associated coronary artery disease and have implications in management<\/p>\n<p><span style=\"color: #0000ff;\"><strong>Types of angina<\/strong><\/span><\/p>\n<p>Chronic stable angina<br \/>\nNocturnal angina<br \/>\nUnstable angina<br \/>\nVariant angina or Prinzmetal&#8217;s angina<br \/>\nCardiac syndrome X &#8211; Microvascular angina<\/p>\n<p><span style=\"color: #0000ff;\"><strong>Unstable Angina<\/strong><\/span><\/p>\n<p>Unstable angina is defined as recurrent episodes of angina on minimal effort or at rest. It may be the initial presentation of coronary artery disease or it may represent the abrupt deterioration of a previously stable angina.<br \/>\nCrescendo angina, preinfarction angina and intermediate chest pain syndrome are also part of the spectrum of unstable angina. Angina is provoked more easily and persists for longer than stable angina. It may fail to respond to therapy. Pain is often associated with reversible ST segment depression on the ECG. Unless vigorously treated, up to 30% of patients may progress to myocardial infarction or death within 3 months<\/p>\n<p><span style=\"color: #0000ff;\"><strong>Prinzmetal&#8217;s\/Variant Angina<\/strong><\/span><\/p>\n<p>Prinzmetal&#8217;s angina is caused by focal spasm of angiographically normal coronary arteries. In about two thirds of patients there is also associated atherosclerotic coronary artery obstruction. In cases where there is atherosclerotic obstruction the vasospasm occurs near the stenotic lesion. The chest pain may occur at rest or wake the patient from sleep. Variant angina may be accompanied by dyspnoea and\/or palpitations<\/p>\n<p><span style=\"color: #0000ff;\"><strong>Cardiac Syndrome\u00a0 X<\/strong><\/span><\/p>\n<p>Cardiac Syndrome\u00a0 X is different from the metabolic Syndrome\u00a0 X. Symptoms and signs of angina occur in spite of angiographically normal coronary arteries. They have evidence of ischemia in the form of a positive exercise test. Syndrome X may be due to microvascular disease and is sometimes called microvascular angina.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Evaluation and management of chest pain: discussion of differential diagnosis and management of various types of angina pectoris.<\/p>\n","protected":false},"author":1,"featured_media":36778,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[9],"tags":[],"class_list":["post-5119","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Evaluation and management of chest pain<\/title>\n<meta name=\"description\" content=\"Evaluation and management of chest pain: discussion of differential diagnosis and management of various types of angina pectoris.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Evaluation and management of chest pain\" \/>\n<meta property=\"og:description\" content=\"Evaluation and management of chest pain: discussion of differential diagnosis and management of various types of angina pectoris.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2010-08-28T12:25:17+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-10-24T14:04:43+00:00\" \/>\n<meta name=\"author\" content=\"Johnson Francis\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Johnson Francis\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Evaluation of Chest Pain Focusing on Angina\",\"datePublished\":\"2010-08-28T12:25:17+00:00\",\"dateModified\":\"2023-10-24T14:04:43+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/\"},\"wordCount\":504,\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"articleSection\":[\"General Cardiology\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/\",\"name\":\"Evaluation and management of chest pain\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"datePublished\":\"2010-08-28T12:25:17+00:00\",\"dateModified\":\"2023-10-24T14:04:43+00:00\",\"description\":\"Evaluation and management of chest pain: discussion of differential diagnosis and management of various types of angina pectoris.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/#primaryimage\",\"url\":\"\",\"contentUrl\":\"\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/evaluation-and-management-of-chest-pain\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Evaluation of Chest Pain Focusing on Angina\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\",\"name\":\"All About Cardiovascular System and Disorders\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\",\"name\":\"Johnson Francis\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"caption\":\"Johnson Francis\"},\"logo\":{\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\"},\"description\":\"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/author\\\/jf\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Evaluation and management of chest pain","description":"Evaluation and management of chest pain: discussion of differential diagnosis and management of various types of angina pectoris.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/","og_locale":"en_US","og_type":"article","og_title":"Evaluation and management of chest pain","og_description":"Evaluation and management of chest pain: discussion of differential diagnosis and management of various types of angina pectoris.","og_url":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/","og_site_name":"All About Cardiovascular System and Disorders","article_published_time":"2010-08-28T12:25:17+00:00","article_modified_time":"2023-10-24T14:04:43+00:00","author":"Johnson Francis","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Johnson Francis","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/#article","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/"},"author":{"name":"Johnson Francis","@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"headline":"Evaluation of Chest Pain Focusing on Angina","datePublished":"2010-08-28T12:25:17+00:00","dateModified":"2023-10-24T14:04:43+00:00","mainEntityOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/"},"wordCount":504,"publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/#primaryimage"},"thumbnailUrl":"","articleSection":["General Cardiology"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/","url":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/","name":"Evaluation and management of chest pain","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#website"},"primaryImageOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/#primaryimage"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/#primaryimage"},"thumbnailUrl":"","datePublished":"2010-08-28T12:25:17+00:00","dateModified":"2023-10-24T14:04:43+00:00","description":"Evaluation and management of chest pain: discussion of differential diagnosis and management of various types of angina pectoris.","breadcrumb":{"@id":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/#primaryimage","url":"","contentUrl":""},{"@type":"BreadcrumbList","@id":"https:\/\/johnsonfrancis.org\/professional\/evaluation-and-management-of-chest-pain\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/johnsonfrancis.org\/professional\/"},{"@type":"ListItem","position":2,"name":"Evaluation of Chest Pain Focusing on Angina"}]},{"@type":"WebSite","@id":"https:\/\/johnsonfrancis.org\/professional\/#website","url":"https:\/\/johnsonfrancis.org\/professional\/","name":"All About Cardiovascular System and Disorders","description":"","publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/johnsonfrancis.org\/professional\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec","name":"Johnson Francis","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","caption":"Johnson Francis"},"logo":{"@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g"},"description":"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal","url":"https:\/\/johnsonfrancis.org\/professional\/author\/jf\/"}]}},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/5119","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/comments?post=5119"}],"version-history":[{"count":5,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/5119\/revisions"}],"predecessor-version":[{"id":61107,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/5119\/revisions\/61107"}],"wp:attachment":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/media?parent=5119"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/categories?post=5119"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/tags?post=5119"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}