Chest pain classification

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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 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.

Classification

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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).