Clinical Features

• Acute retrosternal chest pain

  • Typical: dull, squeezing pressure and/or tightness

  • Commonly radiates to left chest, arm, shoulder, neck, jaw, and/or epigastrium

  • Precipitated by exertion or stress

  • Symptom relief after administration of nitrates is not a diagnostic criterion for cardiac ischemia.

  • The peak time of occurrence is usually in the morning.

• Dyspnea (especially with exertion)

• Pallor

• Nausea, vomiting

• Diaphoresis, anxiety

• Dizziness, lightheadedness, syncope

• Tachycardia, arrhythmias

• Symptoms of CHF (e.g., orthopnea, pulmonary edema) or cardiogenic shock (e.g., hypotension, tachycardia, cold extremities)

• New heart murmur on auscultation (e.g., new S4)

more likely in elderly, diabetic individuals, and women

• Stabbing, sharp chest pain

• No or minimal chest pain:

• Autonomic symptoms (e.g., nausea, diaphoresis)

• Epigastric pain

• Bradycardia

• Clinical triad in right ventricular infarction: hypotension, elevated jugular venous pressure, clear lung fields