How can one distinguish cardiac chest pain from non-cardiac chest pain?

Hi
There is no conclusive way to differentiate between cardiac and non-cardiac chest pain in the home environment. There are many cases where severe heartburn causes chest pain that resembles cardiac disease and only the use of nitrates may allow a person to differentiate between cardiac and non-cardiac chest pain in this instance. Severe chest pain should always be taken seriously and a trip to the emergency room is often warranted to exclude more serious underlying disorders. This can only be done under the supervision of a medical professional in conjunction with the relevant tests and investigations.
Nature

• Cardiac
  • Pain is dull, constricting, choking and/or crushing.
  • Other terms to describe ischemic cardiac chest pain includes squeezing, burning or heavy.
  • Sometimes it may just feel like discomfort which is why the character of cardiac chest pain can be so misleading.
  • A common but inconclusive presentation in cardiac chest pain is a patient clutching the chest (picture below).

• Non-Cardiac
  • The pain may vary from burning to sharp, stabbing and prickling.
  • Chest pain due to anxiety may also result in pain that is similar to cardiac chest pain.

Location

• Cardiac
  • The pain is usually central (towards the center of the chest) and fanning outwards (diffuse).

• Non-Cardiac
  • Pain may be away from the center of the chest where a patient can clearly identify it as a right-sided or left-sided chest pain.
  • Pain is usually localized – located at only one spot which can be clearly pinpointed by the patient.

Radiation

• Cardiac
  • Pain to the jaw, neck, shoulder, arms (either one or even both) or back.
  • Sometimes there pain may be radiated to the upper abdomen.

• Non-Cardiac
  • There may not often be any radiation of the pain or it may radiate to other sites apart from those mentioned above.
  • Gastritis with accompanying GERD may cause a burning chest pain as well as upper abdominal pain and this may be confused for radiation.

Precipitating Factors

• Cardiac
  • Triggered or exacerbated by exertion or emotion.
  • At times a large meal or even extremes of temperature, particularly cold, can trigger or exacerbate the pain.
  • Unstable angina may not be triggered by any specific factors.

• Non-Cardiac
  • Spontaneous although it may be exacerbated by exertion (usually after rather than during activity).
  • Changes in posture, deep or rapid breathing or pressure may also exacerbate the pain.

Relieving Factors

• Cardiac
  • Pain is relieved by rest and responds quickly to nitrates.

• Non-Cardiac
  • Not relieved significantly by rest, if at all.
  • Does not respond to nitrates or there may be a slow response.
  • Pain relived by <NOBR style="FONT-FAMILY: Verdana, Geneva, Helvetica; COLOR: darkblue; FONT-WEIGHT: bold" id=itxt_nobr_26_0>antacids</NOBR> may be related to gastrointestinal disorders. Pain that improves upon leaning forward may be related to the pericarditis (inflammation of the lining around the heart).

Concomitant/Associated Signs and Symptoms

• Cardiac
  • Severe shortness of <NOBR style="FONT-FAMILY: Verdana, Geneva, Helvetica; COLOR: darkblue; FONT-WEIGHT: bold" id=itxt_nobr_27_0>breath</NOBR> – patient may report a feeling of suffocation.
  • Dizziness
  • Fainting spells (‘blackouts’)

• Non-Cardiac
  • Other signs and symptom may be present that is helpful in identifying the cause of the pain.
  • Gastrointestinal – bloating, belching, nausea, vomiting and/or regurgitation. Refer to Gastric Chest Pain.
  • Respiratory – shallow breathing, persistent cough, abnormal breathing sounds, difficulty breathing when lying flat, expectorating mucus or coughing up blood. Refer to Lung Chest Pain.
  • Musculoskeletal – limited range of motion, cannot tolerate pressure on the affected area. Refer to Muscle Chest Pain and Bone Chest Pain.
  • Psychological – weepy, depressed, excited, agitated, fearful. Refer to Nerve Chest Pain.

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Thanks for this thread and to jaya for this post..