Prevalence
Clinical
features
Differential
diagnosis
Investigations
Therapy
Prevention
Prognosis
|  | | | Clinical
features |
Ask about
the pain, specifically its nature
a
Why?
Pressure makes coronary artery disease more likely, but sharp or stabbing pain make it less
likely
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
Post-test Probability |
LR-
(95% CI)
|
Post-test Probability |
central or left-sided chest pain
(pre-test probability: 41%)
a
|
MI or unstable angina
(ECG, cardiac enzymes, stress tests)
|
pressure
|
1.7
(1.4 to
2.0)
|
54% |
0.67
(0.57 to
0.78)
|
32% |
|
|
|
sharp or stabbing pain
|
0.41
(0.29 to
0.63)
|
22% |
1.3
(1.2 to
1.5)
|
48% |
A pleuritic chest pain makes unstable angina or a myocardial infarction unlikely
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
Post-test Probability |
central or left-sided chest pain
(pre-test probability: 41%)
a
|
MI or unstable angina
(ECG, cardiac enzymes, stress tests)
|
pleuritic pain
|
0.0
(0.0 to
0.12)
|
0% |
|
|
|
partly pleuritic pain
|
0.22
(0.13 to
0.39)
|
14% |
|
|
|
pain not pleuritic
|
1.4
(1.3 to
1.6)
|
50% |
Positional chest pain makes unstable angina or a myocardial infarction less likely
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
Post-test Probability |
central or left-sided chest pain
(pre-test probability: 41%)
a
|
MI or unstable angina
(ECG, cardiac enzymes, stress tests)
|
positional pain
|
0.13
(0.030 to
0.54)
|
8% |
|
|
|
pain partly positional
|
0.31
(0.20 to
0.48)
|
18% |
|
|
|
pain not positional
|
1.4
(1.3 to
1.5)
|
49% |
Note:
-
Aching or burning pain is not helpful at diagnosing or excluding myocardial infarction or unstable angina.
a
|
internal medicine