MEDizzy - You are evaluating a 40-year-old male patient in the office

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Acute Complaints

You are evaluating a 40-year-old male patient in the office who is complaining of chest pain. His father had a myocardial infarction at age 42, and the patient is quite concerned. Which characteristic, if included in the history, decreases the likelihood that his chest pain is cardiac in origin?

ExplanationWhen someone presents to the office complaining of chest pain, the history is invaluable in helping determine if the pain is due to a life-threatening cause (myocardial infarction, PE, aortic dissection, and tension pneumothorax, to name a few). The likelihood ratios for the clinical features associated with acute myocardial infarction follow: • Chest pain radiating to the left arm: 2.3 • Chest pain radiating to the right arm: 2.9 • Chest pain associated with nausea or vomiting: 1.9 • Chest pain associated with diaphoresis: 2.0 • Pleuritic chest pain: 0.2 Sharp or stabbing pain (rather than dull, aching, a feeling of pressure, tightness, or squeezing) and positional chest pain also decrease the likelihood that the pain is ischemic.