Chest pain overview: Difference between revisions
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{{Chest pain}} | {{Chest pain}} | ||
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==Overview== | ==Overview== | ||
[[Chest pain]] is [[discomfort]] or [[pain]] that you feel anywhere along the front of your body between your neck and upper [[abdomen]]. | [[Chest pain]] is [[discomfort]] or [[pain]] that you feel anywhere along the front of your body between your neck and upper [[abdomen]]. | ||
==Historical Perspective== | |||
==Classification== | |||
==Pathophysiology== | |||
==Causes== | ==Causes== | ||
There are many organ systems, that when affected, can lead to the symptoms of chest pain. The most common organs involved are the [[heart]], [[lungs]], and the [[digestive system]]. [[Psychiatric disorders]], can also lead to the perception of chest pain. The most important facet of diagnosis is distinguishing the life-threatening causes of chest pain, to the more benign causes. | There are many organ systems, that when affected, can lead to the symptoms of chest pain. The most common organs involved are the [[heart]], [[lungs]], and the [[digestive system]]. [[Psychiatric disorders]], can also lead to the perception of chest pain. The most important facet of diagnosis is distinguishing the life-threatening causes of chest pain, to the more benign causes. | ||
== | ==Differentiating Chest pain from Other Diseases== | ||
There are several life-threatening causes of chest pain which need to be evaluated for first, which include; [[myocardial infarction]], [[aortic dissection]], [[esophageal rupture]], [[pulmonary embolism]], and [[tension pneumothorax]]. The other possible causes of chest pain can be evaluated for by carefully assessing the nature of the pain, and obtaining a thorough patient history. | There are several life-threatening causes of chest pain which need to be evaluated for first, which include; [[myocardial infarction]], [[aortic dissection]], [[esophageal rupture]], [[pulmonary embolism]], and [[tension pneumothorax]]. The other possible causes of chest pain can be evaluated for by carefully assessing the nature of the pain, and obtaining a thorough patient history. | ||
==Epidemiology and Demographics== | |||
==Risk Factors== | |||
==Screening== | |||
==Natural History, Complications, and Prognosis== | |||
==Chest Pain in Pregnancy== | ==Chest Pain in Pregnancy== | ||
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==Diagnosis== | ==Diagnosis== | ||
===Diagnostic Study of Choice=== | |||
===History and Symptoms=== | ===History and Symptoms=== | ||
The symptoms of chest pain can help to discern whether there is an underlying cause that may be dangerous. Symptoms that should cause alarm are; chest pain radiating to the back ([[aortic dissection]]), left arm or jaw pain, [[nausea]], [[vomiting]], lightheadedness, and anginal pain that is different from baseline ([[myocardial infarction]]). Pain that is reproduced with palpation, greatest in the abdominal region, radiating to lower extremities, brought on by inspiration, or brought on my movement or postural changes, is less characteristic of [[myocardial ischemia]]. | The symptoms of chest pain can help to discern whether there is an underlying cause that may be dangerous. Symptoms that should cause alarm are; chest pain radiating to the back ([[aortic dissection]]), left arm or jaw pain, [[nausea]], [[vomiting]], lightheadedness, and anginal pain that is different from baseline ([[myocardial infarction]]). Pain that is reproduced with palpation, greatest in the abdominal region, radiating to lower extremities, brought on by inspiration, or brought on my movement or postural changes, is less characteristic of [[myocardial ischemia]]. | ||
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The key findings to look for on EKG is [[ST elevation]] which is characteristic of [[myocardial infarction]]. Diffuse ST elevation may point to the diagnosis of [[pericarditis]]. Serial EKG's should be obtain to evaluate for continued or progression of myocardial injury over time. | The key findings to look for on EKG is [[ST elevation]] which is characteristic of [[myocardial infarction]]. Diffuse ST elevation may point to the diagnosis of [[pericarditis]]. Serial EKG's should be obtain to evaluate for continued or progression of myocardial injury over time. | ||
=== | ===X-ray=== | ||
[[Chest X-ray]] can be useful in the initial evaluation of the patient to ascertain if there is [[cardiomegaly]], [[pulmonary edema]] and [[aortic dissection]]. [[Computed tomography|CT scanning]] may be better for visualizing the etiology of chest pain depending on the patient history and their symptoms. | [[Chest X-ray]] can be useful in the initial evaluation of the patient to ascertain if there is [[cardiomegaly]], [[pulmonary edema]] and [[aortic dissection]]. [[Computed tomography|CT scanning]] may be better for visualizing the etiology of chest pain depending on the patient history and their symptoms. | ||
===CT=== | ===Echocardiography and Ultrasound=== | ||
===CT scan=== | |||
[[CT angiography]] may be helpful in ruling out a [[pulmonary embolism]]. These tests are sometimes combined with lower extremity venous ultrasound or D-dimer testing. To rule out [[aortic dissection]], a chest [[CT]] scan with contrast, [[MRI]] or transesophageal echocardiography can be used. | [[CT angiography]] may be helpful in ruling out a [[pulmonary embolism]]. These tests are sometimes combined with lower extremity venous ultrasound or D-dimer testing. To rule out [[aortic dissection]], a chest [[CT]] scan with contrast, [[MRI]] or transesophageal echocardiography can be used. | ||
===MRI=== | ===MRI=== | ||
To rule out [[aortic dissection]], a chest [[CT]] scan with contrast, [[MRI]] or transesophageal echocardiography may be done. | To rule out [[aortic dissection]], a chest [[CT]] scan with contrast, [[MRI]] or transesophageal echocardiography may be done. | ||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
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===Medical Therapy=== | ===Medical Therapy=== | ||
A correct diagnosis of the underlying cause of the chest pain should be obtained prior to deciding on an appropriate treatment strategy. The most dangerous causes should be evaluated first. If [[myocardial infarction]] or ischemia is suspected, the immediate pharmacotherapies often used include [[morphine]], [[oxygen]], [[nitrate]], [[aspirin]], and possibly also [[beta-blockers]], [[ACE inhibitors]], [[thrombolytic therapy]] and [[Glycoprotein IIb/IIIa inhibitors]]. | A correct diagnosis of the underlying cause of the chest pain should be obtained prior to deciding on an appropriate treatment strategy. The most dangerous causes should be evaluated first. If [[myocardial infarction]] or ischemia is suspected, the immediate pharmacotherapies often used include [[morphine]], [[oxygen]], [[nitrate]], [[aspirin]], and possibly also [[beta-blockers]], [[ACE inhibitors]], [[thrombolytic therapy]] and [[Glycoprotein IIb/IIIa inhibitors]]. | ||
=== Interventions === | |||
===Surgery=== | ===Surgery=== | ||
Surgery may be indicated in the setting of an MI ([[angioplasty]]) or in an [[aortic dissection]]. | Surgery may be indicated in the setting of an MI ([[angioplasty]]) or in an [[aortic dissection]]. | ||
===Primary Prevention=== | |||
===Secondary Prevention=== | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 02:47, 26 August 2020
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Chest pain overview On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]
Overview
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
Historical Perspective
Classification
Pathophysiology
Causes
There are many organ systems, that when affected, can lead to the symptoms of chest pain. The most common organs involved are the heart, lungs, and the digestive system. Psychiatric disorders, can also lead to the perception of chest pain. The most important facet of diagnosis is distinguishing the life-threatening causes of chest pain, to the more benign causes.
Differentiating Chest pain from Other Diseases
There are several life-threatening causes of chest pain which need to be evaluated for first, which include; myocardial infarction, aortic dissection, esophageal rupture, pulmonary embolism, and tension pneumothorax. The other possible causes of chest pain can be evaluated for by carefully assessing the nature of the pain, and obtaining a thorough patient history.
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Chest Pain in Pregnancy
Causes of chest pain in pregnancy are similar to those in the general population. Acute life-threatening causes include myocardial infarction, aortic dissection, tension pneumothorax, as well as thromboembolic diseases that are more common in pregnancy, such as pulmonary embolism and amniotic fluid embolism. Occasionally, chest pain in pregnant women is caused by physiological changes in pregnancy, namely chest expansion and breast tenderness.
Diagnosis
Diagnostic Study of Choice
History and Symptoms
The symptoms of chest pain can help to discern whether there is an underlying cause that may be dangerous. Symptoms that should cause alarm are; chest pain radiating to the back (aortic dissection), left arm or jaw pain, nausea, vomiting, lightheadedness, and anginal pain that is different from baseline (myocardial infarction). Pain that is reproduced with palpation, greatest in the abdominal region, radiating to lower extremities, brought on by inspiration, or brought on my movement or postural changes, is less characteristic of myocardial ischemia.
Physical Examination
Physical examination should focus on evaluating for the life-threatening causes of chest pain first. A complete physical exam should be done, which includes a thorough cardiac, lung, and abdominal exam.
Laboratory Findings
Serial troponins and CK-MB should be ordered. Additional laboratory tests include serum electrolytes, a complete blood count, renal function tests, and liver function tests.
Electrocardiogram
The key findings to look for on EKG is ST elevation which is characteristic of myocardial infarction. Diffuse ST elevation may point to the diagnosis of pericarditis. Serial EKG's should be obtain to evaluate for continued or progression of myocardial injury over time.
X-ray
Chest X-ray can be useful in the initial evaluation of the patient to ascertain if there is cardiomegaly, pulmonary edema and aortic dissection. CT scanning may be better for visualizing the etiology of chest pain depending on the patient history and their symptoms.
Echocardiography and Ultrasound
CT scan
CT angiography may be helpful in ruling out a pulmonary embolism. These tests are sometimes combined with lower extremity venous ultrasound or D-dimer testing. To rule out aortic dissection, a chest CT scan with contrast, MRI or transesophageal echocardiography can be used.
MRI
To rule out aortic dissection, a chest CT scan with contrast, MRI or transesophageal echocardiography may be done.
Other Imaging Findings
Other imaging studies that may be used in the evaluation of chest pain include V/Q scintigraphy, CT angiogram, and endoscopy.
Other Diagnostic Studies
Other diagnostic studies used in the evaluation of chest pain include cardiac stress testing, peak flow studies, and pulmonary function testing.
Treatment
Medical Therapy
A correct diagnosis of the underlying cause of the chest pain should be obtained prior to deciding on an appropriate treatment strategy. The most dangerous causes should be evaluated first. If myocardial infarction or ischemia is suspected, the immediate pharmacotherapies often used include morphine, oxygen, nitrate, aspirin, and possibly also beta-blockers, ACE inhibitors, thrombolytic therapy and Glycoprotein IIb/IIIa inhibitors.
Interventions
Surgery
Surgery may be indicated in the setting of an MI (angioplasty) or in an aortic dissection.