What are the key clinical features that differentiate between cardiac and non-cardiac causes of chest pain in adults?

Key clinical features differentiating cardiac from non-cardiac chest pain in adults include:

• Cardiac chest pain (angina) characteristics: constricting discomfort located in the front of the chest or radiating to the neck, shoulders, jaw, or arms; precipitated by physical exertion; and relieved by rest or glyceryl trinitrate (GTN) within about 5 minutes ².
• Non-cardiac chest pain features making stable angina unlikely: pain that is continuous or very prolonged; unrelated to activity; brought on by breathing in; or associated with symptoms such as dizziness, palpitations, tingling, or difficulty swallowing ².
• Associated symptoms and risk factors: Cardiac chest pain is often accompanied by breathlessness and occurs in people with cardiovascular risk factors such as older age, male sex, smoking, diabetes, hypertension, dyslipidaemia, family history of premature coronary artery disease, or previous cardiovascular events ².
• Physical examination and investigations: Physical signs of cardiovascular disease or other cardiac conditions (e.g., severe aortic stenosis, cardiomyopathy) support a cardiac cause; absence of such signs and presence of features suggesting musculoskeletal, gastrointestinal, or psychogenic causes point to non-cardiac chest pain ¹,².

In summary, typical anginal pain is exertional, constricting, and relieved by rest or GTN, whereas non-cardiac chest pain tends to be continuous, unrelated to exertion, or associated with respiratory or other systemic symptoms ². Clinical assessment including history, examination, and consideration of risk factors is essential to differentiate cardiac from non-cardiac causes ¹,².