title: Is chest pain still the most important symptom of acute coronary syndrome?
abstract: BACKGROUND
  Acute coronary syndrome (ACS) carries the risk of death due to electrical or haemodynamical disturbances. Thus, rapid in-hospital treatment is necessary. To achieve this, a patient, his family and his physician should correctly diagnose ACS, based mainly on clinical symptoms.
  
  
  OBJECTIVE
  To assess the symptomatology of ACS and to establish whether modern management of ischaemic heart disease did not change ACS clinical characteristics.
  
  
  METHODS
  The study group consisted of 156 consecutive patients (96 males, mean age 65+/-15 years) admitted to hospital due to ACS. Physicians prospectively filled in a questionnaire addressing ACS symptomatology, including chest pain characteristics and clinical symptoms of painless ACS.
  
  
  RESULTS
  Retrosternal chest pain was present in 119 (76%) patients, six (4%) patients had pain localised outside thorax (jaws or epigastric region) whereas 31 (20%) patients had painless ACS. In the latter group the most frequent symptoms were dyspnea and marked weakness.
  
  
  CONCLUSIONS
  Chest pain remains the most frequent symptom of ACS and its prevalence is similar to that previously described in literature. Almost a quarter of patients have painless ACS; in those patients other intensive and sudden symptoms may suggest ACS.
authors.affiliation: Department of Cardiology, Medical Centre for Postgraduate Education, Grochowski Hospital, Warsaw, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Łukaszewicz
authors.forename: Bronisław
authors.initials: B
authors.lastname: Bednarz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Chamiec
authors.forename: Paweł
authors.initials: P
authors.lastname: Maciejewski
authors.forename: Aleksander
authors.initials: A
authors.lastname: Górecki