When a patient has substernal chest pain radiating to the back and jaw that is unresolved by rest, what should you suspect?

Substernal chest pain that radiates to the back and jaw, particularly when it remains unresolved by rest, is highly indicative of acute myocardial infarction (AMI). This type of pain is often described as "angina" and is typically associated with significant cardiovascular events. The key features of this presentation—location, radiation, and persistence—are classic signs of a heart attack.

In the context of an AMI, the pain occurs due to the heart muscle not receiving enough blood, often due to a blockage in one or more coronary arteries. This can lead to a feeling of severe pressure or squeezing in the chest, which can radiate to other areas, including the back, neck, and jaw. Other symptoms may accompany this pain, such as shortness of breath, sweating, and nausea.

Identifying this symptom pattern is crucial for timely intervention. Recognizing that unresolved chest pain may indicate a serious underlying condition, such as myocardial ischemia or infarction, allows for appropriate and expedited emergency care.