A Typical Chest Pain
Chest pain presents differently across individuals. Doctors may consider some symptoms typical and others atypical. For this reason, it is important to recognize a range of symptoms to avoid missing potential signs of a heart attack. This article discusses the differences between atypical and typical chest pain, their potential causes, and diagnostic tests doctors may use to evaluate them.
- It also explores when to contact a doctor and answers common questions about atypical and typical chest pain.
- However, because “atypical” symptoms of a heart attack present more frequently in females than males, some researchers suggest the term may be outdated, and supposedly atypical symptoms are actually typical in certain groups.
Chest pain symptoms may present differently depending on the underlying cause, a person’s sex, their age, and whether they have any preexisting health conditions. According to the current terminology, atypical chest pain symptoms may include :
Intense pain in the upper abdominal area : This may involve discomfort in the location of the stomach, pancreas, and liver, Intense back pain: This may involve burning and stabbing sensations in the back. Severe indigestion-like pain: This may also involve burning and stabbing sensations.
Typical chest pain symptoms may include dull, heavy, tight, and crushing pain in the chest that can spread to the arm and jaw. Research suggests females may experience atypical chest pain symptoms that indicate a heart attack more often than males. Therefore, some researchers suggest it may be useful to discontinue the terms “typical” and “atypical” regarding chest pain or provide a reference for differentiating symptoms that are more or less likely depending on sex.
pneumonia a pulmonary embolism pericarditis, which is inflammation of the membrane surrounding the heart pericardial tamponade, which is a fluid buildup, usually blood, on the hearta tear in the aorta acute coronary syndrome, which is any condition that reduces blood flow to the heart, such as a heart attack
Other conditions that may cause chest pain include:
musculoskeletal issues gastroesophageal reflux disease chicken pox or shingles a tear in the esophagus
The lists above are not exhaustive, and it is best for a person to speak with a healthcare professional if they experience any typical or atypical chest pain symptoms. Anyone who suspects they are experiencing a heart attack or other life threatening condition or health event should seek medical attention immediately by calling 911.
When a person has either atypical or typical chest pain, a healthcare professional may ask for more details about the onset of the symptoms and their medical history. For example, they may ask what the person was doing when symptoms started. They may also want to know more about any family history of heart disease and whether the person smokes,
In addition, a person will likely receive a physical exam and undergo various diagnostic tests, These may include :
an EKG blood tests, such as a complete blood count or basic metabolic panel a chest X-ray a CT scan to look at blood vessels in the lungsan echocardiogram, which is an ultrasound of the hearta cardiovascular MRI
Experts suggest that healthcare professionals always consider a life threatening cause if a person has chest pain, for example, a heart attack or pulmonary embolism. Due to atypical symptoms frequently occurring in females having heart attacks, it is important not to discount abdominal pain as a symptom.
Females may sometimes not have any chest pain at all and only report abdominal pain. When a person has chest pain, it is always best to speak with a doctor or healthcare professional. Chest pain can be acute or chronic, meaning it may come on suddenly or come and go over time. Chronic chest pain, whether atypical or typical, can be a sign of a serious underlying condition.
For example, if the pain results from a cholesterol buildup slowly reducing blood flow to the heart, it is important to manage this to reduce the person’s risk of a heart attack. Sudden atypical or typical chest pain may be a sign of an immediately life threatening condition, such as a heart attack.
- In this case, a person will need to call 911.
- Atypical and typical chest pain symptoms can indicate many conditions, some of which may be life threatening.
- During a heart attack, females tend to experience intense abdominal pain and back pain more frequently than typical symptoms such as tightness in the arm, jaw, and chest.
Because of this, the terms “atypical” and “typical” may not accurately describe the different types of chest pain. As what is atypical for males appears not to be for females, some researchers are now calling for separate diagnostic criteria for people of different sexes.
Contents
What is the difference between typical and atypical chest pain?
Abstract – Studies indicate that symptoms labeled as “atypical” are more common in women evaluated for myocardial infarction (MI) and may contribute to the lower likelihood of a diagnosis and delayed treatment and result in poorer outcomes compared with men with MI. Atypical pain is frequently defined as epigastric or back pain or pain that is described as burning, stabbing, or characteristic of indigestion. Typical symptoms usually include chest, arm, or jaw pain described as dull, heavy, tight, or crushing. In a recent article published in the Journal of the American Heart Association ( JAHA ), Ferry and colleagues addressed presenting symptoms in men and women diagnosed with MI and reported that typical symptoms in women were more predictive of a diagnosis of MI than for men. A critical question is, are there really typical or atypical symptoms, and if so, who is the reference group? We propose that researchers and clinicians either discontinue using the terms typical and atypical or provide the reference group to which the terms apply (eg, men versus women). We believe it is past time to standardize the symptom assessment for MI so that proper and rapid diagnostic testing can be undertaken; however, we cannot standardize the symptom experience. When we do this, we are at risk of having study results, such as those of Ferry and colleagues, that vary from prior evidence and could lead to what the authors hope to avoid: disadvantaging women in receiving expeditious diagnostic testing and treatment for acute coronary syndrome. Keywords: acute coronary syndrome, clinical presentation, myocardial infarction, sex differences, symptoms Subject Categories: Clinical Studies, Ischemia Symptoms are the trigger that propel individuals with symptoms suspicious of acute coronary syndrome (ACS) to seek emergent care for this potentially life‐threatening condition. After 3 decades of research on sex differences in the symptoms of ACS, ample evidence suggests that although sex differences in symptoms exist, they are modest and do not contribute significantly to risk stratification or provide a rationale for diagnostic testing based on sex. In a large prospective study, we found that only 3 of 13 common symptoms were predictive of a diagnosis of ACS versus non‐ACS. The predictive value of shoulder pain (odds ratio: 2.53 versus 1.11 ) and arm pain (odds ratio: 2.15 versus 1.21 ) for women were nearly twice that of men. Shortness of breath was predictive of a non‐ACS diagnosis for men only.1 Scores of authors have found some sex differences in symptoms of ACS, 2, 3 but small differences were usually based on frequency and distribution of symptoms, not the type of symptom. In many studies, statistical significance was reached when sex differences were as small as a few percentage points. Kahn et al 4 found, for example, that men reported chest pain more frequently than women (86.3% versus 81%; P =0.03). We must distinguish between clinical significance (whether the magnitude of difference is large enough to change clinical care) and statistical significance (which is subject to variability in sampling and measurement) in assessing patients for further intervention. A more critical issue than sex differences in symptoms is likely the magnitude of symptom overlap in individuals ruled in and out for ACS. Approximately 10% to 15% of patients presenting to the emergency department (ED) with symptoms suggestive of ACS are actually experiencing ACS, 5, 6 yet the other 85% of patients look so similar that the same diagnostic testing and resources are required to safely rule them out for ACS. Numerous clinical‐decision aids to assess risk for ACS in the ED have been validated over the years, some with 100% sensitivity.5 Many of these clinical‐decision or prediction rules have facilitated transfer of low‐risk patients to a chest‐pain or clinical‐decision unit or early discharge from the ED.7 In a recent article published in the Journal of the American Heart Association ( JAHA ), Ferry et al 8 addressed presenting symptoms in men and women diagnosed with myocardial infarction (MI) using sex‐specific criteria in a substudy of the High‐STEACS (High‐Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome) trial. The definition of sex‐specific criteria were troponin levels >99th percentile, which are 16 ng/L for women and 34 ng/L for men.9 The rationale for the study was that sex‐specific thresholds for troponin have identified a population of patients with MI that was previously unrecognized. Therefore, these patients would have been excluded from prior research on sex differences in symptoms. In addition, “atypical” symptom presentations are more common in women than men and may contribute to the lower likelihood of a diagnosis and treatment and result in poorer outcomes compared with men with MI. Atypical pain was defined by Greenslade et al 10 as “epigastric or back pain or pain that was described as burning, stabbing, characteristic of indigestion, or other.” Typical symptoms included “chest, arm, or jaw pain described as dull, heavy, tight, or crushing.” The main study finding was that typical symptoms in women were more predictive of a diagnosis of MI than those in men. We address several limitations to study methods that may mislead researchers, clinicians, and the public. In the High‐STEACS parent study, 16% of men and 12% of women had type 1 MI (myocardial necrosis with troponin levels >99th percentile or myocardial ischemia on the ECG) and the remainder had type 2 (myocardial necrosis caused by increased oxygen demand or decreased supply).8 Importantly, patients with ST‐segment–elevation MI (STEMI) were excluded from the study. The authors stated that patients with STEMI were not included because symptom differences are less important, as the diagnosis is based primarily on the ECG rather than on other features of the clinical presentation. Although ECG criteria for STEMI account for sex and age differences, 11 there are still notable delays in timely reperfusion among women with STEMI compared with men. Jneid et al 12 found that women with STEMI were less likely to receive fibrinolytic therapy alone, primary PCI, or the combination of fibrinolytic therapy and PCI (5.1% versus 6.2%, 47.3% versus 61.1%, and 3.9% versus 5.8%, respectively; P <0.0001). Women presenting with STEMI were also less likely to achieve timely door‐to‐needle time (28.3% versus 35.2%; P0.0005) and timely door‐to‐balloon time (39.0% versus 44.8%; P 13 found that another factor contributing to women's less timely reperfusion was longer prehospital delay compared with men. This finding is concerning because ECGs are frequently not obtained within the recommended 10 minutes of arrival, and in one study, women with ischemic‐type symptoms had a mean time of 53 minutes from presentation to ECG.14 It is vitally important to remember that symptoms are cues for patients that a problem exists. Symptoms trigger clinicians to obtain ECGs, which drive subsequent clinical decision‐making such as activation of the cardiac catheterization laboratory for emergent percutaneous coronary intervention.15 Nearly all patients presenting to the ED are undifferentiated. Neither the patient nor the clinician knows what the diagnosis is until testing is complete. Many emergency medical systems now have the capacity to do prehospital ECGs, Nevertheless, we found in our recent study that only 44.6% of patients with ACS arrived at the ED via emergency medical systems. In addition, a minority of patients (24.6%) experienced STEMI, and only 56.3% of patients with STEMI called emergency medical systems. This leaves a large number of patients presenting to the ED without a diagnosis.13 In addition, individuals presenting to emergency medical systems with chest pain are significantly more likely to receive prehospital ECG compared with those who have nonchest symptoms. Consequently, despite greater availability of prehospital ECG equipment, if the patient does not report chest pain, then they are disadvantaged from even receiving a prehospital ECG.16 Including patients with STEMI is vital to determining true differences or similarities in symptoms between female and male patients, particularly because STEMI is a true emergency requiring time‐dependent reperfusion therapy. In the Clinical Perspective section of their article, Ferry et al 8 state that women with MI are at risk of underdiagnosis and undertreatment if "correct" symptom presentations are not recognized. Researchers, including our team, have spent years attempting to identify sex differences in the symptoms of ACS to provide evidence for clinicians to facilitate expeditious diagnosis and for the public to be able to respond quickly to symptoms. To suggest that there is a "correct" presentation implies there is an "incorrect" symptom presentation, which is not supported by numerous previous studies.1, 17, 18 Assuming a correct presentation can also imply that there is a "standard" symptom presentation, also unsupported by the data to date. The critical question is, are there really typical or atypical symptoms, and if so, who is the reference group? We propose that researchers and clinicians either discontinue using the terms typical and atypical or provide the reference group to which the terms apply (eg, men versus women). Many researchers have reported that upper back pain and fatigue are commonly reported symptoms during ACS, and up to 30% of patients do not experience chest pain.19, 20 This information is important to consider as we try to differentiate patients who will be ruled in compared with those ruled out for ACS. We found that although chest pain is a sensitive symptom for ACS, it is not very specific ( Table ).1 In fact, few other symptoms were sensitive or specific for a diagnosis of ACS. In our multicenter prospective study, we found few symptom differences between patients with and without ACS presenting to the ED.13 Ferry et al 8 defined chest pain as all descriptors of chest symptoms, including pressure or discomfort. Their rationale was that terms other than pain are "functions of sex‐related language rather than symptom differences in symptom presentation." This is an opinion that is counterproductive to science and accurate assessment of symptoms, which are, by definition, subjective and what the patient says they are.
What is atypical chest pain symptoms?
Musculoskeletal chest pain – You may experience atypical chest pain in case of injuries or if you have certain conditions that can occur to your ribs and chest muscles. For example, people may feel pain in their chest because of costochondritis, which causes cartilage inflammation between their ribs.
- This condition can cause sharp and dull chest pain that people can confuse with the symptoms of a heart attack.
- If you have sharp chest pain but also experience symptoms such as nausea, dizziness, and radiating pain, you should call 911 or local emergency services immediately.
- To diagnose the source of atypical chest pain, a doctor may need to perform a series of tests to rule out conditions that could cause your discomfort.
A doctor or healthcare professional will start to assess your health conditions with a physical examination and by monitoring your heart to rule out any life threatening event. To determine whether the atypical chest pain has cardiac causes, a doctor will initially conduct an electrocardiogram along with blood tests, including a cardiac enzyme (troponin) test,
- A chest X-ray may also be done as well as a cardiac MRI scan,
- A doctor may also recommend blood and imaging tests, such as X-rays or CT scans, to rule out lung cancer, pneumonia, or any other lung-related and musculoskeletal condition.
- If doctors suspect the cause of atypical chest pain is linked to GERD, they may recommend you have an esophagogastroduodenoscopy test to rule out any GERD complication.
They may prescribe you some medications to manage acid reflux. The type of treatment that a doctor will recommend depends on the cause of atypical chest pain. Treatment may include medications and surgery. Medications for atypical chest pain treatment include: A doctor may recommend you undergo surgery if they need to repair a tear in your gastroesophageal tract because of acid reflux or if you don’t respond to medications for stomach acid management.
Doctors may also consider surgical treatment in case of certain circulatory conditions such as aortic stenosis. Lung cancer and pulmonary embolism may also require surgery. The outlook for people with atypical chest pain depends on its causes. When the cause of atypical chest pain is heart-related, your condition may require immediate treatment and could be life threatening,
The earlier doctors give a diagnosis and treat the heart condition, the better the outlook usually is. The outlook for people with conditions such as lung cancer can vary depending on the stage of cancer. People with other conditions, such as pneumonia and GERD, usually have a good outlook.
Most people recover or their symptoms improve after treatment. Atypical chest pain can have cardiac- and noncardiac-related causes. You may experience atypical chest pain if you have lung or gastrointestinal conditions. You may also feel discomfort in your chest if you’ve injured your ribs or if the cartilage in between them has inflammation.
Atypical chest pain usually feels like a sharp stabbing pain in your chest. If you also feel dizzy or weak, have difficulty breathing, or the pain is radiating to other areas of your body, you should get medical attention. Doctors have to diagnose the cause of your discomfort before they can advise the most effective treatment to improve your symptoms.
What are 3 features of typical chest pain?
Heart-related chest pain – Chest pain is often associated with heart disease. But many people with heart disease say they have a mild discomfort that they wouldn’t really call pain. Chest discomfort due to a heart attack or another heart problem may feel like:
Pressure, fullness, burning or tightness in the chest. Crushing or searing pain that spreads to the back, neck, jaw, shoulders, and one or both arms. Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or varies in intensity. Shortness of breath. Cold sweats. Dizziness, lightheadedness or weakness. Racing heartbeats. Nausea or vomiting.
What is typical versus atypical?
Typical vs Atypical Antipsychotics – Typical antipsychotics have been around for decades, while atypical antipsychotics have been developed more recently. Both are effective in treating serious psychiatric disorders but work differently inside the body and can have different side effects.
Atypical antipsychotics are a newer class of medication used to treat conditions like schizophrenia and bipolar disorder. These medications work by blocking the action of dopamine in the brain, which helps to reduce symptoms such as hallucinations and delusions. Atypical antipsychotics have become increasingly popular over time due to their reduced risk for serious side effects (like stroke or seizures), compared with typical antipsychotics because they don’t block as many neurotransmitters in the brain.
Typical antipsychotics are older medications that have been around longer, and were developed to treat schizophrenia and other psychotic disorders. They work by blocking dopamine receptors but also block other neurotransmitters like serotonin, norepinephrine, or acetylcholine.They tend to be less expensive than atypical antipsychotics, but they may cause more severe side effects, such as movement problems (e.g., stiffness or tremors).
The main difference between the two types of antipsychotics is that the first-generation (typical) drugs block dopamine, and the second-generation drugs (atypical) block dopamine and affect serotonin levels. In addition, evidence suggests that some second-generation drugs have milder movement-related side effects than first-generation drugs.
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Why is atypical better than typical?
Atypical antipsychotics have greater effects on serotonin. Both groups of antipsychotics share similar side effects, such as dry mouth, sleepiness, and weight gain. But typical antipsychotics have a higher risk of uncontrollable body movements.
Is it non typical or atypical?
Not typical ; not conforming to the type; irregular; abnormal: atypical behavior; a flower atypical of the species.
What does typically atypical mean?
: not typical : irregular, unusual. an atypical form of a disease.
What is the difference between typical and atypical AP?
Typical antipsychotics tend to more strongly block dopamine. Atypical antipsychotics have greater effects on serotonin. Both groups of antipsychotics share similar side effects, such as dry mouth, sleepiness, and weight gain. But typical antipsychotics have a higher risk of uncontrollable body movements.
How do you differentiate chest pain?
How It Feels – Chest pain from a heart attack often feels like a large amount of pressure, tightness, burning, or squeezing in the chest, In comparison, chest pain that feels like a sharp or knife-like pain resulting from coughing or breathing is likely not due to a heart attack.
What is meant by atypical symptoms?
Describes a state, condition, or behavior that is unusual or different from what is considered normal. In medicine, an atypical lesion or growth in or on the body may be benign (not cancer), precancerous or premalignant (likely to become cancer), or malignant (cancer). Also called abnormal.
