Disorders that affectthoracicor abdominal organs
— the heart, pleurae, lungs, esophagus, rib cage,gallbladder, pancreas, or stomach — are typical causes of chest pain. It can also result from a musculoskeletal or hematologic disorder, anxiety, and drug therapy. Chest pain is an important indicator of several acute and life-threatening cardiopulmonary and GI disorders.The onset of chest pain can be sudden or gradual, and its cause may initially be difficult to ascertain. Chest pain canradiate to the arms, neck, jaw, or back. It can be steady or intermittent, mild or acute. And it can range in character froma sharp shooting sensation to a feeling of heaviness, fullness, or even indigestion. Chest pain can be provoked or aggravated by stress, anxiety, exertion, deep breathing, or eating certain foods.
Sudden, severe chest pain requires prompt evaluation and treatment because it may herald a life-threatening disorder. (See Managing severe chest pain, pages 76 and 77.) Standardized algorithms are used toaddress the treatment regimen of the patient with chest pain. Determine the time of onset and whether it wassudden or gradual. Ask the patient about precipitating, alleviating, or aggravating factors, if the pain radiates,and associated signs and symptoms. Ask him to rate the pain using a standardized pain rating scale. Obtain a12-lead electrocardiogram (ECG) and a blood sample for serum testing. Administer oxygen through a nasalcannula. Place the patient on a cardiac monitor and establish I.V. access. If test results indicate an acutemyocardial infarction (MI), the patient will require emergency percutaneous coronary intervention or fibrinolytic therapy. Be prepared to administer emergency care if the patient experiences cardiopulmonaryarrest.
Differential Diagnosis of Chest PainCardiovascular
Typical angina pectoris
Prinzmetal’s or variant angina
Unstable or accelerating angina
Acute myocardial infarction
Mitral valve prolapse