Study note
MedicineCardiology

Clinical assessment of exertional chest discomfort

THE CONTEXT
Detailed history-taking is crucial for identifying the likely cause of chest discomfort and assessing features suggesting angina.

History and risk assessment

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Chest discomfort on exertion suggests angina pectoris. Reproducibility, predictability and a relationship to physical exertion, occasionally emotion, are the most important symptom features.
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Establish symptom duration: recent-onset angina carries greater risk than long-standing, unchanged symptoms.

Physical examination

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Examination is often normal. Xanthoma or xanthelasma may indicate hyperlipidaemia, a cardiovascular risk factor.
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Look for anaemia and thyrotoxicosis, both of which can exacerbate angina.
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Cardiovascular examination may reveal left ventricular dysfunction or murmurs associated with aortic valve disease and hypertrophic cardiomyopathy.
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Bruits and loss of peripheral pulses may indicate other manifestations of arterial disease.
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