Fast Five Quiz: Acute Coronary Syndrome

Yasmine S. Ali, MD


May 17, 2023

Substernal chest pain (sometimes described as crushing or a pressure-like feeling on or in the chest) radiating between the jaw and/or left arm is the classic presentation of ACS. However, the presenting complaint may be subtle and include broader complaints such as diaphoresis, difficulty breathing, epigastric pain, isolated pain in the jaw or left arm, lightheadedness, nausea, and weakness.

Cool, clammy skin and diaphoresis are signs of cardiogenic shock, not fever and flushing. In the physical exam, heart sounds are frequently normal. At times, gallop and murmur can be heard. A thorough physical exam is critical to ruling out potentially life-threatening differentials; the presence of abdominal tenderness on palpation may suggest pathologies such as gastritis or pancreatitis. A workup for pulmonary emboli would be suggested upon the presence of unilateral leg swelling.

Learn more about the clinical presentation of ACS.


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