CHEST PAIN

BY
DR. OMAIMA FATHY
E.R. SPECIALIST

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 Chest pain
Common complaint of acute care settings.

5% of ED visits.

3-10% discharged inappropriately.

Differentiating between ischemic and non-

ischemic causes can be difficult.

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Severity of Chest pain correlates
with gravity of its cause

WRONG

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 Pathophysiology
Alternate pain fibers are classified into 2 broad categories  Visceral &
Somatic.

Pain from visceral fibers is more difficult to describe & is precisely

localized.

Those experiencing visceral pain are more likely to use terms such as
discomfort, heaviness, or aching.

Visceral pain fibers are found in internal organs such as blood vessels.

Further, patients frequently misinterpret the origin of visceral pain because

it is the esophagus, and the visceral pleura.

The dermis and parietal pleura are innervated by somatic pain fibers.

pain from somatic fibers is usually easily described, precisely located, often
referred to a different area of the body corresponding to an adjacent
somatic nerve experienced as a sharp sensation.

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Causes of chest pain
Cardiac

Vascular

Pulmonary

Gastrointestinal

Musculoskeletal

Others
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 Cardiac causes

Coronary artery disease

Aortic stenosis

Hypertrophic
cardiomyopathy

Pericarditis
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Vascular causes

Aortic dissection

Pulmonary embolism

Pulmonary hypertension

Right ventricular strain

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 Pulmonary causes

Pleuritis or pneumonia

Tracheobronchitis

Pneumothorax

Tumor

Mediastinitis or mediasinal emphysema

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Gastrointestinal causes
Eosophageal perforation

Eosophageal reflux

Eosophageal spasm

Mallory-Wiss tear

Peptic ulcer disease

Biliary disease

Pancreatitis

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Musculoskeletal causes
Cervical disk disease

Arthritis of the shoulder or spine

Costochondritis

Intercostal muscle cramps

Subacromial bursitis

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 Others

Disorders of the breast

Chest wall tumors

Herpes zoster

Emotional
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 CAD
Stable angina pectoris

Unstable angina pectoris

Decubitus angina

Prinzmetal’s (variant) angina

Cardiac syndrome X

Acute myocardial infarction

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 Stable angina
Chest pain is described as heaviness, tightness, pressure,
squeezing, or choking. Lasts for 1-5 minutes.

Typically pain is central/retrosternal and may radiate to, left

shoulder, both arms, back, neck, jaw, teeth, or
epigastrium.

Episodes are typically caused by exertion or emotion and are

relieved by rest or sublingual nitrates.

Angina may be precipitated by unfamiliar tasks, a heavy meal

or exposure to cold.

May be accompanied by light-headedness, palpitations,

diaphoresis , dyspnea, nausea, or vomiting.
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THANK YOU

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