A 57-year-old male client is brought to the emergency department (ED) by emergency medical services (EMS) with reports of chest pain. Client was mowing his lawn and noticed chest pain presenting as tightness and pressure. The pain continued to increase over about 30 minutes when the client decided to rest. The client's wife called emergency medical services (EMS) when the pain was unrelieved after 20 minutes of rest. Client reports no other incidents of experiencing this pain. His medical history includes hypertension, obesity, and a 20 year history of smoking, having quit about 5 years ago. Takes metoprolol succinate ER 25 mg PO. Exhibits For each assessment finding, click to specify if the finding is consistent with angina or myocardial infarction, or both. Each column must have at least one response option selected.

Epigastric distress: Epigastric discomfort can occur in both angina and myocardial infarction due to referred pain or visceral irritation from ischemia. Clients may confuse this with indigestion, particularly in atypical presentations. Occurring without cause: Myocardial infarction pain often occurs suddenly and unpredictably, including during rest or sleep. It is not always precipitated by physical exertion or emotional stress, unlike classic stable angina. Pain only relieved by opioids: Myocardial infarction pain is severe and typically not responsive to nitroglycerin alone. Relief often requires opioid analgesics like morphine, which also help reduce cardiac workload. Feelings of fear: A sense of impending doom or intense anxiety is commonly reported in both angina and myocardial infarction, likely due to sympathetic nervous system activation during cardiac distress. Chest pain radiating down arm: Radiation of pain, especially to the left arm, is classic in both angina and myocardial infarction. It reflects the shared neural pathways between the heart and upper extremity. Pain relieved by nitroglycerin: Angina is typically responsive to rest and nitroglycerin, which dilates coronary arteries and reduces oxygen demand. In contrast, MI pain often persists despite nitroglycerin.