Angina Pectoris in Emergency Medicine Differential Diagnoses

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