Chest pain classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3]


Chest pain traditionally has been classified into typical and atypical types. Chest pain that is more likely associated with ischemia includes of substernal chest discomfort aggravated by exertion or emotional stress and relieved by rest or nitroglycerin. Ischemic chest discomfort can be described based on quality, location, radiation, and provoking and relieving factors. Using the term of atypical chest pain is problematic. Although the term of atypical chest pain was intended to describe angina without typical chest symptoms, it is more often used to consider that the symptom is noncardiac in origin. Then, based upon the ACC/AHA Guideline 2021, it is discouraged to use the term of atypical chest pain. Notably, chest pain is a broadly term to define referred pain in the shoulders, arms, jaw, neck, and upper abdomen. So, using the terms of cardiac, possible cardiac, and noncardiac are encouraged to describe the nature of chest pain.


Chest pain is classified into three subgroups including cardiac, possible cardiac, and noncardiac.

Cardiac The initial assessment should be focused on investigation about myocardial ischemia
Non-cardiac The term of atypical chest pain should not be used, because of misinterpretation of cardiac chest pain as benign in nature
Possible cardiac
Acute chest pain New onset, or change in pattern, intensity, duration of chest pain compared with prior episode
Stable chest pain Chronic symptoms , worsening with exertional or emotional stress

Characteristics of cardiac chest pain:

Chest pain characteristics and corresponding causes
Onset and duration
Location and radiation
Precipitating factors
Relieving factors
Associated symptoms
The above table adopted from 2021 AHA/ACC/ASE Guideline[1]


  1. Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ (November 2021). "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. PMID 34709879 Check |pmid= value (help).