• Non-Cardiac
  • The pain may vary from burning to sharp, stabbing and prickling.
  • Chest pain due to anxiety may also result in pain that is similar to cardiac chest pain.

Location

• Cardiac
  • The pain is usually central (towards the center of the chest) and fanning outwards (diffuse).

• Non-Cardiac
  • Pain may be away from the center of the chest where a patient can clearly identify it as a right-sided or left-sided chest pain.
  • Pain is usually localized – located at only one spot which can be clearly pinpointed by the patient.

Radiation

• Cardiac
  • Pain to the jaw, neck, shoulder, arms (either one or even both) or back.
  • Sometimes there pain may be radiated to the upper abdomen.

• Non-Cardiac
  • There may not often be any radiation of the pain or it may radiate to other sites apart from those mentioned above.
  • Gastritis with accompanying GERD may cause a  burning chest pain as well as upper abdominal pain and this may be confused for radiation.

Precipitating Factors

• Cardiac
  • Triggered or exacerbated by exertion or emotion.
  • At times a large meal or even extremes of temperature, particularly cold, can trigger or exacerbate the pain.
  • Unstable angina may not be triggered by any specific factors.

• Non-Cardiac
  • Spontaneous although it may be exacerbated by exertion (usually after rather than during activity).
  • Changes in posture, deep or rapid breathing or pressure may also exacerbate the pain.

Relieving Factors

• Cardiac
  • Pain is relieved by rest and responds quickly to nitrates.

• Non-Cardiac
  • Not relieved significantly by rest, if at all.
  • Does not respond to nitrates or there may be a slow response.
  • Pain relived by antacids may be related to gastrointestinal disorders. Pain that improves upon leaning forward may be related to the pericarditis (inflammation of the lining around the heart).

Concomitant/Associated Signs and Symptoms

• Cardiac
  • Severe shortness of breath – patient may report a feeling of suffocation.
  • Dizziness
  • Fainting spells (‘blackouts’)

• Non-Cardiac
  • Other signs and symptom may be present that is helpful in identifying the cause of the pain.
  • Gastrointestinal – bloating, belching, nausea, vomiting and/or regurgitation. Refer to Gastric Chest Pain.
  • Respiratory – shallow breathing, persistent cough, abnormal breathing sounds, difficulty breathing when lying flat, expectorating mucus or coughing up blood. Refer to Lung Chest Pain.
  • Musculoskeletal – limited range of motion, cannot tolerate pressure on the affected area. Refer to Muscle Chest Pain and Bone Chest Pain.
  • Psychological – weepy, depressed, excited, agitated, fearful. Refer to Nerve Chest Pain.