A typical anginal attack is readily recognized, as it comes on suddenly after exertion or after a large meal, is characterized by pain of a substernal pressure type radiating to the left arm, and is relieved by standing still for a minute or two or by the use of vasodilators such as glyceryl trinitrate. An attack of coronary thrombosis can best be described clinically as an attack of angina with excruciating pain which is not relieved by glyceryl trinitrate and can be relieved only by repeated large doses of morphine. The sense of impending death is also associated with such an attack. As long as the pain is limited to the chest or arms diagnosis is not difficult, but when it radiates to the abdomen, or especially when it is almost entirely limited to the abdomen, it is often erroneously diagnosed as acute indigestion.
Because of the suddenness of the
J. P. ANDERSON. DIFFERENTIATION BETWEEN CORONARY THROMBOSIS AND ACUTE ABDOMINAL CONDITIONS. JAMA. 1928;91(13):944–947. doi:10.1001/jama.1928.02700130022006