Today, 23 years later, “atypical chest pain” is still popular in medical circles. However, its meaning remains uncertain. Some articles have the term in the title, but do not define or discuss it in their text.11,12 In other articles, the term refers to non-cardiac causes of chest pain.13-15 A recent review defines it as “chest pain not caused by myocardial ischemia”16, while another simply recommends avoiding the term.17 And a brief report concludes: “What do we really mean by atypical chest pain? In reality, we do not want to say anything. 18 A complete medical history and physical examination are essential to support the diagnosis of angina pectoris (stable) and to rule out other (acute) causes of chest pain such as acute coronary syndrome, aortic dissection, arrhythmias, pulmonary embolism, pneumothorax or pneumonia (of tension), gastroesophageal reflux disease or spam, hyperventilation or musculoskeletal pain. [1] In addition, specific laboratory and cardiac tests are often required. Atypical chest pain is defined as chest pain that does NOT have the three characteristics of chest pain typical of a heart attack. These typical indicators include: 1) chest pain or discomfort in the middle of the chest behind the sternum, 2) worsens with exertion or stress, and 3) improves with rest or a drug called nitroglycerin. This article examines the symptoms, causes, and management of atypical chest pain. Atypical chest pain is different from chest pain, which indicates a heart attack.
Symptoms include sharp or heartbreaking pain, shortness of breath and back pain. Nowadays, it is quite difficult to ensure good health care without using Humpty Dumpty terminology. Instead of “atypical chest pain,” I recommend “chest pain,? Cause”20 or “unexplained chest pain”. This would reduce the risk of misunderstandings, remind us of our ignorance, make us think, and keep us honest with ourselves and our patients. Atypical chest pain is also known as atypical/probable angina pectoris. However, angina pectoris has certain properties that can help distinguish other causes of (chest) pain. Angina pectoris is usually short and progressive in appearance and shift, with intensity increasing and decreasing over several minutes. The pain does not change with breathing or position. If patients have already had angina, they are often able to recognize the pain immediately. [5] Angina pectoris is a manifestation of arterial failure and usually occurs with an increasing demand for oxygen such as during exercise. As soon as demand decreases (e.g.
by stopping the exercise), complaints usually disappear within minutes. Another way to relieve pain is to administer nitroglycerin. Nitro-glycerin spray is a vasodilator that reduces venous return to the heart, thereby reducing the workload and therefore the oxygen demand. It also dilates the coronary arteries and increases coronary blood flow. [6] However, the reaction to nitroglycerin is not specific to angina pectoris, a similar reaction can be observed with esophageal spasms or other gastrointestinal problems, as nitroglycerin relaxes smooth muscle tissue. [7] Some causes of atypical chest pain may not require treatment and may be clinically monitored by you and your doctor. For example, mild musculoskeletal pain that doesn`t bother you can be monitored. Nonspecific chest pain: If ≤ 1 of the criteria for classical angina pectoris are present, the symptoms are classified as non-specific. Stable angina (pecturis) is a clinical syndrome characterized by discomfort in the chest, jaw, shoulder, back or arms, usually caused by exertion or emotional stress, and relieved by rest or nitroglycerin. It can be attributed to myocardial ischemia, which is most often caused by atherosclerotic coronary artery disease or aortic valve stenosis.
Typical chest pain is also called permanent angina, classic angina pectoris, or typical angina pectoris. Treatment involves rest as well as over-the-counter nonsteroidal anti-inflammatory drugs. Corticosteroid injection to relieve pain and inflammation is performed occasionally. Both the esophagus and stomach are located in or near the chest, and disorders of these organs can cause atypical chest pain, such as the following. Atypical chest pain can be treated through monitoring, medication, or procedures. If the pain is severe or you experience shortness of breath or have a history of heart disease, you should seek medical attention immediately. Injuries to the muscles or bones of the chest are another common cause of atypical chest pain. Musculoskeletal pain can be due to a direct injury to the breast, which can lead to tissue damage and broken ribs, as well as breast injuries due to overuse. If you have a history of heart disease, consider going straight to the emergency room or calling an ambulance.
Heart attacks can also cause atypical chest pain, so it`s important to be examined and treated by a doctor immediately. Aside from a heart attack, other heart causes can cause atypical chest pain. Some of them are: Other symptoms of atypical chest pain will likely be as follows. Atypical chest pain describes the situation in which a person`s chest pain is unlikely to be related to heart or lung disease. There are many other possible causes that could explain chest pain, such as chest wall muscle pain or psychological factors such as stress and anxiety. If you develop symptoms of atypical chest pain such as the following, you should consult immediately: Atypical angina pectoris (likely) Chest pain occurs when 2 out of 3 criteria of classical angina pectoris are present. Many people have no symptoms. Some have unexplained chest pain, shortness of breath, fainting, or the feeling of a fast, floating heartbeat because the abnormally thick heart muscle disrupts the normal heartbeat and causes an arrhythmia. Take the patient to the emergency room or call 9-1-1. Whether chest pain is typical or not depends mainly on the perception of “typical”. This perception, in turn, depends on the depth of medical knowledge and the time spent assessing the patient.
Remember that in individual cases, the manifestations of a disease are found somewhere on a bell-shaped curve. If we are not familiar with the manifestations at both ends of the curve, we will interpret them as atypical, although they are in fact typical. In other words, the pain can be really atypical for the condition we are thinking about (for example, angina pectoris), but clearly typical of the one we are not thinking about (necrosis of the pericardial fat pad). Moreover, eager to prove our first impression, we can launch an “unsuccessful search for infallibility”19, resulting in a variety of misdirected, expensive, time-consuming and sometimes dangerous studies. Dissatisfied with my search for clarity, I decided to determine what “atypical chest pain” meant for 50 doctors – 25 practicing internists and 25 heads of the house of internal medicine. About half of the group believed the term meant atypical pain for angina. Almost as many thought it meant pain of unknown cause. One person described the term as meaningless, and some admitted to using it to admit a patient to the hospital, thus postponing other considerations. Two doctors said they diagnosed “atypical chest pain” when they tried to convince a counselor to take care of the patient or perform a special procedure such as esophagoscopy or cardiac catheterization.
