"Myocardial infarct? Naah...just send her home!!"

That sentence may be heard a lot in our workplace. A chest pain may be interpreted as an angina or just a muscle pain. Indeed the muscle is in pain, but to determine "which muscle?" may be the most difficult choice we've ever made. Either we send a patient home because of the nontypical chest pain leading to costochondritis, or we have to keep the patient in because we suspect of an angina.

Well, we learned from med school that we HAVE TO suspect a person for having an angina by several typical criteria:
1. Dull chest pain (heaviness or pressure on the chest), cannot be exactly pointed by the patient
2. Pain radiating to left arm or shoulder
3. Pain radiating to the jaw or to the back

However, we tend to exclude the possibility of someone having angina pectoris if they don't have any of the symptoms mentioned above. How wrong could this be??
Well, based on a review by Swap and Nagurney (2005), some symptoms were accounted and calculated to show the likelihood ratio of having acute myocardial Infarction:

1. Pain radiating to the right arm or shoulder (LR, 4.7)
2. Pain radiating to both arms or shoulders (LR, 4.1)
3. Association between pain and exertion (LR, 2.4)
4. Pain radiating to the left arm (LR, 2.3)
5. Diaphoresis (LR, 2.0)
6. Pain described as worse than previous angina or similar to previous MI (LR, 1.8)
7. Pain described as pressure was not very predictive of ACS (LR, 1.3)

I believe these facts might just slap your face. Well, believe it or not, you just have to prove it for yourself in the ER. Just remember what A/Prof. Amal Mattu said, there is no patient with chest pain can be considered as "no risk" for MI.