Which chest pain pattern would warrant immediate triage for possible acute coronary syndrome?

Which chest pain pattern would warrant immediate triage for possible acute coronary syndrome?

• A. Localized chest wall tenderness reproducible with palpation
• B. Substernal chest pain with radiation to arm/jaw, dyspnea, sweating, nausea; lasting more than a few minutes
• C. Chest pain with inspiration
• D. Pain relieved by rest after a few minutes

Answer: (B)

Recognizing patterns that signal possible acute coronary syndrome and require urgent triage is being tested here. Substernal or central chest pain that radiates to the arm or jaw, with associated symptoms like shortness of breath, sweating (diaphoresis), and nausea, and that lasts more than a few minutes, is the presentation most strongly linked to ischemia. The radiation to a distant site (arm or jaw) plus autonomic symptoms reflects myocardial ischemia activating the sympathetic system, and a duration longer than a few minutes points away from brief, benign causes toward an acute cardiac event. Because ACS can progress rapidly to myocardial infarction, this pattern warrants immediate triage and urgent evaluation (eg, ECG and cardiac enzymes). In contrast, localized chest wall tenderness reproducible with palpation is more suggestive of a musculoskeletal source, chest pain that occurs with inspiration is often pleuritic or non-cardiac, and pain that is relieved by rest after only a few minutes is less specific for ACS.

Recognizing patterns that signal possible acute coronary syndrome and require urgent triage is being tested here. Substernal or central chest pain that radiates to the arm or jaw, with associated symptoms like shortness of breath, sweating (diaphoresis), and nausea, and that lasts more than a few minutes, is the presentation most strongly linked to ischemia. The radiation to a distant site (arm or jaw) plus autonomic symptoms reflects myocardial ischemia activating the sympathetic system, and a duration longer than a few minutes points away from brief, benign causes toward an acute cardiac event. Because ACS can progress rapidly to myocardial infarction, this pattern warrants immediate triage and urgent evaluation (eg, ECG and cardiac enzymes). In contrast, localized chest wall tenderness reproducible with palpation is more suggestive of a musculoskeletal source, chest pain that occurs with inspiration is often pleuritic or non-cardiac, and pain that is relieved by rest after only a few minutes is less specific for ACS.