Page 17 - Clinical Pearls in Cardiology

History and General Examination 5

cardiac pain has similar characteristics, but it may vary
in intensity. The typical characteristics of ischemic pain
include the following:

Characteristics of ischemic cardiac pain
1. Central part of chest or slightly to the left
2. May be radiating along the inner side of
arm, shoulder region, neck, epigastrium,
Location
lower jaw, teeth, etc. (i.e. referred pain)
3. Pain may be only present in the areas of
radiation and not in the chest
1. Squeezing, pressing or constricting type
of pain
2. Sometimes described as strangling
feeling or heaviness
Nature
3. Occasionally described as either burning
or stabbing
4. More common in morning due to
increased sympathetic tone
1. Patient may indicate that the pain has
a constricting nature or he may hold a
clenched fist in front of his chest
Body language
2. Peculiar type of facial expression called
as ‘angor animi’
3. Cold, clammy extremities in some cases
1. Unaccustomed physical exertion may
precipitate pain
Precipitating 2. Extremes of emotion may precipitate
and pain
relieving factors 3. Heavy meals may precipitate pain
4. Pain may be relieved with rest
5. Sublingual nitrates may alleviate pain
The C fibers carrying nociceptive pain signals from
the heart converge on the same area of the spinal cord
(i.e. substantia gelatinosa of T1 to T5 spinal segments)
where somatic nerve fibers form the peripheral T1 to T5
dermatomes converge. Hence, the brain may sometimes