Differential diagnosis

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Sometimes it is difficult to distinguish belween angina and other cardiac or non-cardiac causes of chest pain, including oesophageal pain (Table 3.8). The distinction involves an overall assessment of the clinical situation. Atypical symptoms occurring on exertion and relieved by rest in a 60-year-old man with a strong family history of coronary heart disease and a history of diabetes are probably angina. Conversely, even a characteristic history is unlikely to represent angina if the patient is a non-smoking, young adult female with no relevant family history or past medical history.

Precordial catch is the term that has been used to describe a stabbing pain usually at the cardiac apex, it is a common sensation experienced by many normal subjects which may cause undue anxiety. It is not a feature of organic heart disease.

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