clinical presentation and differential diagnosis of angina

CLINICAL PRESENTATION


Although there is significant individual variation, the patient usually has substernal pain (pressure, tightness, heaviness, sharp pain, sensation similar to intestinal gas or dysphagia). The pain is of short duration (30 seconds to 30 minutes) and nonpleuritic and is often accompanied by shortness of breath, nausea, diaphoresis, and numbness or pain in the left arm, jaw, or shoulder. In some patients, dyspnea, not chest discomfort, is a manifestation of myocardial ischemia and is called angina equivalent.




DIFFERENTIAL DIAGNOSIS
Noncardiac pain mimicking angina may be caused by the following:

	1.	Pulmonary diseases (pulmonary hypertension, pulmonary embolism, pleurisy, pneumothorax, pneumonia)
	2.	Gastrointestinal disorders (peptic ulcer disease, pancreatitis, esophageal spasm, esophageal reflux, cholecystitis, cholelithiasis)
	3.	Musculoskeletal conditions (costochondritis, chest wall trauma, cervical arthritis with radiculopathy, muscle strain, myositis)
	4.	Acute aortic dissection
	5.	Herpes zoster
	6.	Mitral valve prolapse
	7.	Anxiety