III. DIAGNOSIS
A. Pain Pattern
1. Location
The pain of angina is usually felt in the center of the chest over the breastbone, and only rarely over the breasts (see Fig. 3 in the chapter Heart Attacks). Pain in the lower jaw accompanied by pain in the chest or arms during a walk or strenuous activity is nearly always due to angina, especi¬ally if these symptoms recur during similar activities. Sometimes the discomfort is only in the upper arm with a tingling feeling in the fingers; this pain comes mainly on exertion as opposed to pain produced, for example, by a pinched nerve. A pinched nerve will cause similar discomfort in the arms and fingers when the individual is at rest, but an activity, such as walking, makes little difference.
2. Severity and Character
The pain of angina may be mild to moderate and only occasionally severe. Often it is just discomfort. The individual may even refuse to use the word pain to de¬scribe the peculiar sensation that feels like a tightness or a heavy weight on the breastbone. To some it is a burn¬ing sensation; to others it is a feeling of strangulation or suffocation that fortunately disappears within one to five minutes of rest, either with the individual standing or sitting. The pain of angina rarely lasts more than 10 minutes. If an individual has pain similar to that described and lasts more than 15 minutes, the patient should take two or three soft, chewable aspirins (80 mg each) and go immediately to a hospital emergency room.