Location continued:

• His pain is substernal with radiation to the back and left shoulder.
• Pain due to irritation of the diaphragmatic surface of the pericardium is often referred via the phrenic nerve to the left supraclavicular area and trapezius ridge.
• When present, trapezius ridge pain is felt by many experts to be virtually pathognomonic for pericardial inflammation.
• Pericardial pain is usually not associated with the anxiety so commonly found with angina.
• Note that the patient would not go to Emergency.