Chest pain

​Chest Pain Chest  pain  is  a  common  symptom  and  may  be  a  manifestation  of  cardiovascular  or noncardiovascular  disease.  Full  characterization  of  the  pain  with  regard  to  quality  (squeezing, tightening,  pressing,  burning),  quantity,  frequency,  location,  duration,  radiation,  aggravating  or alleviating  factors  and  associated  symptoms  can  help  to  distinguish  the  cause.  All  patients  presenting to  a  hospital  with  severe  or  persistent  chest  pain  should  have  a  full  set  of  vital  signs,  an  ECG,  and  a CXR.  **The  life-threatening  causes  that  must  be  considered  and  ruled  out  in  all  patients with  severe,  persistent  chest  pain. Cardiac  Causes Angina/Myocardial  infarction  **   Substernal  pressure  +/-  radiation  to  neck,  jaw,  Left  arm   Duration usually  >  1  minute  and  <  12  hours  for  angina   Associated  with  dyspnea,  diaphoresis,  nausea/vomiting   Worsened with exertion, relieved  with  rest  or  nitroglycerin   Infarction  is  same  as  angina  except  increased  intensity  and  duration   ECG: look for  ST  elevations  or  depressions,  T  wave  inversions Pericarditis/Myocarditis  **   Sharp pain radiation  to  trapezius   Aggravated  by  respiration,  relieved  by  sitting  forward   Listen  for  pericardial  friction  rub   ECG: look for  diffuse  ST  elevations  and  PR  depressions Aortic  Dissection  **   Sudden onset of  tearing  chest  pain,  knife-life  pain   Radiation to back     Usually severely  hypertensive  (can  become  hypotensive)   Asymmetric blood pressure  in  arms  and  asymmetric  pulses  bilaterally   Widened mediastinum  on CXR, new aortic insufficiency  murmur Pulmonary Causes Pneumonia **   A very common cause of chest  pain  in  our  settings   Pleuritic  in  nature   Associated  with  dyspnea,  cough,  fever,  sputum  production   Presents  with  fever,  tachycardia,  crackles  on  physical  exam   CXR should show an infiltrate Pneumothorax **   Sharp, pleuritic  pain  +/-  shortness  of  breath   Unilateral  hyperresonance  and  decrease

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