Diagnosis
2
Table 3. Alternative Diagnoses to Angina for Patients with
Chest Pain
Nonischemic
Cardiovascular Pulmonary Gastrointestinal Chest Wall Psychiatric
Aortic
dissection
Pulmonary
embolism
Esophageal
Esophagitis
Spasm
Reflux
Costochondritis
Fibrositis
Rib fracture
Sternoclavicular
arthritis
Herpes zoster
(before the rash)
Anxiety
disorders
Hyper-
ventilation
Panic
disorder
Primary
anxiety
Pericarditis Pneumothorax
Pneumonia
Pleuritis
Biliary
Colic
Cholecystitis-
Choledocholithiasis
Cholangitis
Peptic ulcer
Pancreatitis
Affective
disorders (ie,
depression)
Somatiform
disorders
ought
disorders
(ie, fixed
delusions)
Table 4. Pretest Likelihood of Coronary Artery Disease (CAD)
in Symptomatic Patients According to Age and Sex
a
Age, y
Nonanginal Chest Pain Atypical Angina Typical Angina
Men Women Men Women Men Women
30-39 4 2 34 12 76 26
40-49 13 3 51 22 87 55
50-59 20 7 65 31 93 73
60-69 27 14 72 51 94 86
a
Each value represents the percent with significant CAD on catheterization.
Adapted from Forrester and Diamond. N Engl J Med. 1979;300:1350-8.
Table 5. Comparing Pretest Likelihood of CAD in Low-Risk
Symptomatic Patients With High-Risk Symptomatic
Patients
Age, y
Nonanginal Chest Pain Atypical Angina Typical Angina
Men Women Men Women Men Women
35 3-35 1-19 8-59 2-39 30-88 10-78
45 9-47 2-22 21-70 5-43 51-92 20-79
55 23-59 4-21 45-79 10-47 80-95 38-82
65 49-69 9-29 71-86 20-51 93-97 56-84
Each value represents the percentage with significant CAD. e first is the percentage for a low-risk,
mid-decade patient without diabetes mellitus, smoking, or hyperlipidemia. e second is that of
a patient of the same age with diabetes mellitus, smoking, and hyperlipidemia. Both high- and
low-risk patients have normal resting ECGs. If ST-T-wave changes or Q waves had been present, the
likelihood of CAD would be higher in each entry of the table. Reprinted from Pryor et al. Am J Med.
1991;90:553-62.
