The character of the pain is usually described as heavy, tight, gripping or crushing, or even ‘like an elephant standing on my chest’. The terms ‘pricking’, ‘burning’ and ‘pinching’ are not usually used by patients whose first language is English, although these terms have been encountered in true PJ34 among those for whom English is their second language. Left submammary pain is extremely unlikely to be anginal. The relationship to exercise is of paramount importance although, of course, unstable angina will occur at rest. In general, the main differential diagnosis is often of oesophageal pain from which it may be totally indistinguishable (Table 1).
Table 1.
Main differential diagnoses of angina
Cardiac
Pericarditis
Myocarditis
Myocardial infarction
Pulmonary embolism
Pulmonary hypertension
Non-cardiac
Oesophageal pain
Peptic ulcer pain
Biliary colic
Musculoskeletal pain
Anxiety
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