Which physical exam finding is most indicative of angina pectoris?

Substernal chest pain with a third heart sound is indicative of angina pectoris because it aligns with the classic presentation of myocardial ischemia. Angina typically presents as a feeling of pressure, tightness, or pain in the chest, often described as substernal discomfort. The presence of a third heart sound, also known as S3, may suggest heart failure or volume overload conditions that can coexist with ischemic heart conditions. While angina itself is characterized by pain triggered by exertion or stress and alleviated by rest or nitroglycerin, the combination of substernal pain with an abnormal heart sound may indicate an underlying dysfunction related to ischemia.

In contrast, left-sided chest pain accompanied by a rash may suggest a dermatological condition or herpes zoster, rather than angina. Reproducible chest pain on palpation is more indicative of musculoskeletal pain, such as costochondritis, rather than an ischemic origin. Lastly, substernal chest pain with jugular venous distention typically points to heart failure or acute decompensation rather than classic angina pectoris. Thus, the combination of substernal chest pain and a third heart sound is the most consistent with the pathophysiology of angina