Features of anginal chest pain

The characteristics of discomfort present in angina can be divided into four categories:

• Site:
  • generally the pain of angina is retrosternal and spreads across the chest. Only rarely is the pain localised - this is generally muscular chest wall pain
  • radiation: the pain of angina generally radiates out from the chest, the commonest sites of radiation include:
    • neck and throat - causing a feeling of suffocation, strangulation, choking
    • jaw - this may be interpreted as a problem with dentures or toothache
    • down one or both arms - generally this is felt down the inside of the arm, under the axilla to the inner two fingers. By contrast, muscular pain generally runs over the shoulder and down the outside of the arm
    • other sites include the back, the abdomen and areas of previous injury. Often angina is misinterpreted as indigestion
      
      
• Character:
  • the pain is often described as constricting, "vice" or "band-like". The patient may place his/her hand across the chest or clench the fist to emphasise the point. Generally the pain builds up rather than being maximal at its onset. Note however that tightness is often perceived as breathlessness: ask what this means - is it tightness or winded feeling?
  • not usually sharp or stabbing in character and is not influenced by respiration or relieved by antacids and simple analgesia (2)
  • the discomfort has no relationship to the severity of the underlying coronary disease (1)
  • pain may be associated with dyspnoea and atypical symptoms like fatigue or faintness, nausea, burping, restlessness, or a sense of impending doom (1)
    
    
• Duration:
  • usually not more than 10 min in most patients (typically for 3-5 minutes) (1)
    
    
• Precipitants:
  • angina occurs when there is an increase in oxygen demand that cannot be met by supply. Some possible precipitants include exertion (e.g. climbing stairs), emotion, a large meal, cold windy weather. Rest brings relief within a few minutes
  • nitrates typically offer rapid relief (1)

Notes:

• non anginal chest pains lack the above mentioned qualities, discomfort may be present in a small portion of the left hemithorax, last for several hours or even days, not relieved by nitroglycerin (except in oesophageal spasm) and may be aggravated by palpation (1)
• Reference:
• 1. Fox K et al. Guidelines on the management of stable angina pectoris: executive summary. European Heart Journal 2006;27(11):1341-1381
• 2. Scottish Intercollegiate Guidelines Network (SIGN) 2007. Management of stable angina