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{{CMG}}; {{AE}} {{Sara.Zand}} {{Aisha}}  
{{CMG}}; {{AE}} {{Sara.Zand}} {{Aisha}}  
==Overview==
==Overview==
[[Chest pain]] traditionally has been classified into [[typical]] and atypical types. [[Chest pain]] that is more likely associated with [[ischemia]] consists of substernal [[chest discomfort]] aggravated by [[exertion]] or [[emotional stress]] and relieved by [[rest]] or [[nitroglycerin]]. The classic description of [[chest discomfort]] is based on [[quality]], [[location]], [[radiation]], and provoking and relieving factors, is more likely to be of cardiac [[ischemic]] origin. Using the term of [[atypical chest pain]] is problematic. Although it was intended to address [[angina]] without typical [[chest]] [[symptoms]], it is more often used to state that the [[symptom]] is [[noncardiac]] in origin. Then, it is discouraged the use of atypical [[chest pain]]. Notably, [[chest pain]] is broadly defined to also include referred pain in the [[shoulders]], [[arms]], [[jaw]], [[neck]], and upper [[abdomen]]. So, using the terms of [[cardiac]], possible [[cardiac]], and [[noncardiac]] to describe the suspected causes of [[chest pain]] are encouraged.
[[Chest pain]] traditionally has been classified into [[typical]] and atypical types. [[Chest pain]] that is more likely associated with [[ischemia]] includes of substernal [[chest discomfort]] aggravated by [[exertion]] or [[emotional stress]] and relieved by [[rest]] or [[nitroglycerin]]. [[Ischemic chest discomfort]] can be described based on [[quality]], [[location]], [[radiation]], and provoking and relieving factors. Using the term of [[atypical chest pain]] is problematic. Although the term of atypical [[chest pain]] was intended to describe [[angina]] without typical [[chest]] [[symptoms]], it is more often used to consider that the [[symptom]] is [[noncardiac]] in origin. Then, based upon the [[ACC/AHA Guideline]] 2021, it is discouraged to use the term of atypical [[chest pain]]. Notably, [[chest pain]] is a broadly term to define referred [[pain]] in the [[shoulders]], [[arms]], [[jaw]], [[neck]], and upper [[abdomen]]. So, using the terms of [[cardiac]], possible [[cardiac]], and [[noncardiac]] are encouraged to describe the nature of [[chest pain]].


==Classification==
==Classification==
[[Chest pain ]] is classified into three subgroups including [[cardiac]], possible [[cardiac]], and [[noncardiac]].
* Non-cardiac [[chest pain]] is used when the etiology of [[chest pain]] is not related to the [[heart]].
* The term of Non-cardiac [[chest pain]] is encouraged to use instead of atypical [[chest pain]], because atypical [[chest pain]] is a misleading description.
* Cardiac [[chest Pain]] means more than pain in the [[Chest]]. It can also mean [[pressure]], [[tightness]], or [[discomfort]] in the [[chest]], [[shoulders]], [[arms]], [[neck]], [[ back]], upper [[abdomen]], or [[jaw]], as well as [[shortness of breath]] and [[fatigue]], should all be considered [[anginal]] equivalents.
*The current classification system that is endorsed by ACC/AHA 2021 is shown below:
{| style="width:75%; height:200px" border="1"
{| style="width:75%; height:200px" border="1"
|-  
|-  
| [[Cardiac]] || The initial assessment  should be focused on investigation about [[myocardial ischemia]]
| [[Cardiac]] || The initial assessment  should be focused on investigation about [[myocardial ischemia]]
|- style="height:100px"  
|- style="height:100px"  
| Non-[[cardiac]] || style="width:200px" || The term of [[atypical chest pain]] should not be used, because of misinterpretation of  [[cardiac ]] [[chest pain]] as benign in nature
| Non-[[cardiac]] || The term of [[atypical chest pain]] should not be used, because of misinterpretation of  [[cardiac ]] [[chest pain]] as benign in nature
|-
|-
| Possible cardiac ||  
| Possible cardiac ||  
|-  
|-  
| Acute [[chest pain]] || New onset, or change in pattern, intensity, duration of [[chest pain]] compared with period episode
| Acute [[chest pain]] || New onset, or change in pattern, intensity, duration of [[chest pain]] compared with prior episode
|- style="height:100px"  
|- style="height:100px"  
| Stable [[chest pain]]|| Chronic [[symptoms]] , worsening with [[exertional]] or [[emotional stress]]
| Stable [[chest pain]]|| Chronic [[symptoms]] , worsening with [[exertional]] or [[emotional stress]]
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Characteristics of cardiac chest pain:
 
 
 
* [[Chest pain ]] is classified into three subgroups including [[cardiac]] , possible cardiac, and [[noncardiac]] etiology.
* Non-cardiac [[chest pain]] is used when the etiology of [[chest pain]] is not related to the [[heart]].
* The term of Non-cardiac [[chest pain]] is encouraged to use instead of atypical [[chest pain]], because atypical [[chest pain]] is a misleading description. 
* Cardiac [[chest Pain]] means more Than Pain in the [[Chest]].
*[[Pain]], [[pressure]], [[tightness]], or [[discomfort]] in the [[chest]], [[shoulders]], [[arms]], [[neck]], [[ back]], upper [[abdomen]], or [[jaw]], as well as [[shortness of breath]] and [[fatigue]], should all be considered [[anginal]] equivalents.
{| style="border: 2px solid #4479BA; align="left"
{| style="border: 2px solid #4479BA; align="left"
! style="width: 1000px; background: #4479BA;" | {{fontcolor|#FFF|Chest pain characteristics and corresponding causes}}
! style="width: 1000px; background: #4479BA;" | {{fontcolor|#FFF|Chest pain characteristics and corresponding causes}}

Latest revision as of 06:35, 6 May 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3]

Overview

Chest pain traditionally has been classified into typical and atypical types. Chest pain that is more likely associated with ischemia includes of substernal chest discomfort aggravated by exertion or emotional stress and relieved by rest or nitroglycerin. Ischemic chest discomfort can be described based on quality, location, radiation, and provoking and relieving factors. Using the term of atypical chest pain is problematic. Although the term of atypical chest pain was intended to describe angina without typical chest symptoms, it is more often used to consider that the symptom is noncardiac in origin. Then, based upon the ACC/AHA Guideline 2021, it is discouraged to use the term of atypical chest pain. Notably, chest pain is a broadly term to define referred pain in the shoulders, arms, jaw, neck, and upper abdomen. So, using the terms of cardiac, possible cardiac, and noncardiac are encouraged to describe the nature of chest pain.

Classification

Chest pain is classified into three subgroups including cardiac, possible cardiac, and noncardiac.

Cardiac The initial assessment should be focused on investigation about myocardial ischemia
Non-cardiac The term of atypical chest pain should not be used, because of misinterpretation of cardiac chest pain as benign in nature
Possible cardiac
Acute chest pain New onset, or change in pattern, intensity, duration of chest pain compared with prior episode
Stable chest pain Chronic symptoms , worsening with exertional or emotional stress


Characteristics of cardiac chest pain:

Chest pain characteristics and corresponding causes
Nature
Onset and duration
Location and radiation
Severity
Precipitating factors
Relieving factors
Associated symptoms
The above table adopted from 2021 AHA/ACC/ASE Guideline[1]

References

  1. Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ (November 2021). "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. PMID 34709879 Check |pmid= value (help).