Prevalence of atypical chest pain descriptions in a population from the southern United States

Introduction: The character of chest pain (CP) is a major factor determinin g triage and admission for patients presenting to the emergency department (ED). Previous studies have found atypical descriptions in as little as 10- 15% of patients with true myocardial ischemic pain. Atypical descriptions m ay be more prevalent in the Deep South of the United States because of cult ural differences in the semantic description of pain. Methods: A retrospect ive study of patients presenting to the ED of a southern U.S. urban hospita l with enzyme-documented myocardial infarction was conducted to determine t he prevalence of atypical CP descriptions. A multivariate analysis of those patients with atypical pain descriptions was conducted to determine the in dependent demographic factors associated with these descriptions. Results: In a total of 77 subjects (56% black; 44% white) meeting the study criteria , 43% were found to have atypical elements in the character of their CP des criptions. Only the black race demographic was round to be significantly co rrelated with the atypical descriptions. The use of the descriptive term "s harp" accounted for nearly half of the atypical presentations. Conclusion: Regional differences in the description of the character of CP may result i n misleading portrayals of ischemic heart disease in southern U.S. populati ons. These differences are associated with a higher prevalence of atypical CP because of semantic distinctions, such as the use of the term "sharp" as a descriptor of acuity rather than character or quality.