Diagnostic potential of chest pain characteristics in coronary care

OBJECTIVES: To characterize and quantitate the experience of presenting chest pain in coronary care patients in terms of intensity, quality, localization and extension of pain. DESIGN: Localization of presenting chest pain at a body figure and estimation of intensity according to the Borg CR-10 scale of five qualities related to pain: (i) aching, (ii) burning, pricking, (iii) pressing, throbbing, (iv) dyspnoea, suffocation and (v) anxiety were done within 24 h from onset of symptoms. SETTING: Coronary care unit (CCU). SUBJECTS: Eighty consecutive patients of which 40 suffered from acute myocardial infarction (AMI). RESULTS: The AMI and non-AMI groups did not differ with regard to (i) the intensity of chest pain being mainly of moderate degree and (ii) the mean number of qualities of the presenting chest pain that were between 3 and 4. Patients with AMI reported extension of chest pain over a wider body area than patients in the non-AMI group (P < 0.0001). A second type of chest pain in addition to the major type of chest pain was reported by only 25% of the patients with AMI compared to 68% in the non-AMI group (P < 0.0001). CONCLUSIONS: Intensity, quality and localization of presenting acute chest pain in patients admitted to the CCU do not differentiate between patients with or without AMI. Extension of pain over a major part of the chest-related body surface and the absence of secondary pain appear to identify at least half of the patients with ongoing AMI.