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Angina Pectoris in Emergency Medicine Differential Diagnoses

  • Author: Marc D Haber, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Feb 18, 2015
 
 

Diagnostic Considerations

As previously stated, there is no standard presentation of angina. One must be vigilant for anginal equivalents, such as breathlessness or diaphoresis, in all subgroups of patients.

No amount of testing can routinely be performed in the emergency department setting to definitively rule out angina as the cause of a patient's chest pain or suspected anginal equivalent.

Reproducible chest wall pain is found in roughly 10% of all cases of AMI.[14]

Missed MIs account for approximately 10% of malpractice claims against emergency physicians and 24% of payout.[15, 16]

Other conditions to be considered in the differential diagnosis of patients with suspected angina include the following:

  • Abdominal aortic aneurysm
  • Anxiety disorders
  • Aortic dissection
  • Boerhaave syndrome
  • Biliary colic
  • Cardiomyopathy, hypertrophic
  • Cholecystitis
  • Coronary artery atherosclerosis
  • Coronary artery vasospasm
  • Gastric ulcers
  • Gastritis, acute
  • Gastroesophageal reflux disease
  • Hiatal hernia
  • Hypercholesterolemia, familial
  • Hypercholesterolemia, polygenic
  • Hypertension
  • Hyperventilation syndrome
  • Isolated coronary artery anomalies
  • Kawasaki disease
  • Panic disorder
  • Peptic ulcer disease
  • Pericardial effusion
  • Pericarditis, acute
  • Pleurodynia
  • Pneumothorax
  • Polyarteritis nodosa
  • Pott disease (tuberculous spondylitis)
  • Pulmonary hypertension, primary
  • Pulmonary hypertension, secondary
  • Scleroderma
  • Takayasu arteritis
  • Tietze syndrome
  • Varicella-zoster virus anemia
  • Esophageal spasm
  • Pneumonia with pleural involvement

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Marc D Haber, MD Assistant Professor, Department of Emergency Medicine, Tufts University School of Medicine; Clinical Associate of Radiology, Baystate Medical Center; Past President of Young Physician Section, AAEM

Marc D Haber, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Radiology, Radiological Society of North America, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas A Brunell, MD, MA, FACEP, FAAEM Director, Emergency Medicine Education, St Francis Hospital and Medical Center; Assistant Professor of Traumatology and Emergency Medicine, University of Connecticut Medical Center

Thomas A Brunell, MD, MA, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Massachusetts Medical Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jeffrey L Arnold, MD, FACEP Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Jerry R Balentine, DO, FACEP, FACOEP Vice President, Medical Affairs and Global Health, New York Institute of Technology; Professor of Emergency Medicine, New York Institute of Technology College of Osteopathic Medicine

Jerry R Balentine, DO, FACEP, FACOEP is a member of the following medical societies: American College of Emergency Physicians, New York Academy of Medicine, American College of Osteopathic Emergency Physicians, American Association for Physician Leadership, American Osteopathic Association

Disclosure: Nothing to disclose.

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