Approaching Chest Pain

Approaching Chest Pain

Chest pain is a common symptom that can be caused by a variety of factors. Identifying the cause of chest pain is crucial for determining the appropriate treatment plan.

1. Information Gathering on Chest Pain:

When approaching a patient with chest pain, it’s essential to gather information such as:

• Time of onset: Did the chest pain appear suddenly or gradually?

• Circumstances of onset: Did the chest pain occur during exertion, rest, eating, or emotional stress?

• Location of pain: Where is the chest pain located? In the middle of the chest, left chest, or right chest?

• Quality of pain: Is the pain heavy, stabbing, crushing, or suffocating?

• Intensity of pain: Is the pain mild, moderate, or severe?

• Duration of pain: How long does the pain last?

• Accompanying symptoms: Wheezing, sweating, nausea, vomiting?

• Factors that reduce/increase pain: Does the pain decrease or increase with rest, movement, or medication?

2. Classification based on Pain Duration:

• Angina: Pain lasting less than 15 minutes.

• Acute Myocardial Infarction (AMI): Pain lasting over 30 minutes.

3. Cardiovascular Conditions Causing Chest Pain:

• Stable angina: Chest pain that occurs during exertion and subsides with rest.

• Acute Coronary Syndrome (ACS): Complete blockage of a coronary artery due to a blood clot or atherosclerosis. Pain lasting over 30 minutes, unresponsive to nitrates, often accompanied by sweating, nausea, and a feeling of impending doom.

• Aortic dissection: The inner layer of the aorta is damaged, allowing blood to enter the middle layer leading to separation of the inner and middle layers. Chest pain radiating to the back, may be accompanied by loss of femoral or radial pulses on one side, and blood pressure discrepancy.

• Pulmonary embolism (PE): A blood clot blocks a pulmonary artery. Severe chest pain with rapid breathing and coughing up blood.

• Pericarditis: Chest pain worsens when turning over, lying flat on the back, and improves when sitting up.

4. Mechanisms of Chest Pain:

• Stable angina: Due to myocardial ischemia caused by coronary artery narrowing due to atherosclerosis. The pain feels heavy, crushing, often located in the center or left chest, radiating to the inner aspect of the left arm, the 4th and 5th fingers, or up to the jaw. Pain usually subsides within 5 minutes of resting or taking nitroglycerin.

• Acute coronary syndrome: Due to complete blockage of a coronary artery, causing severe myocardial ischemia. Chest pain is similar to angina, but more intense and lasting longer.

• Aortic dissection: Due to damage to the inner layer of the aorta, causing blood to enter the middle layer, separating the inner and middle layers.

• Pulmonary embolism: Due to a blood clot blocking a pulmonary artery, causing ischemia in the lungs.

• Pericarditis: Due to inflammation of the pericardium, causing chest pain during activity or lying on one’s side.

5. Respiratory, Digestive, and Neuromuscular Conditions Causing Chest Pain:

• Respiratory conditions: Pneumonia, pleurisy.

• Digestive conditions: GERD (gastroesophageal reflux disease), esophageal spasms, peptic ulcer disease, gallstones.

• Neuromuscular conditions: Costochondritis (Tietze’s syndrome), Herpes Zoster infection.

6. Diagnostic Tests:

• Echocardiogram: Assesses heart function, detects structural and functional abnormalities in the heart.

• Transesophageal echocardiogram: Provides detailed evaluation of heart structures, especially coronary arteries.

• Chest CT scan: Evaluates lung, heart, and aortic structures, detects abnormalities in structure and function.

7. Note:

Approaching chest pain should be done by a specialist to ensure an accurate diagnosis and appropriate treatment plan. Self-diagnosis and treatment can be dangerous to your health.

Disclaimer:

This article is intended to provide general information and should not be considered as medical advice. Please contact a doctor for proper consultation and diagnosis.