By

Jawad Ahmed
 Chest pain is any discomfort between your abdomen (belly) and your
neck. The discomfort may stay in your chest. It may radiate (move or
travel) to other places, such as your shoulder or back. Your
discomfort may feel like tightness, burning, or pressure in your chest.
Your chest pain may be sharp or dull. The discomfort may range from
mild to severe. You may have other symptoms with your chest pain,
such as nausea (upset stomach) or vomiting (throwing up).
 What causes chest pain?
There are many things that can cause chest pain. Also, certain things may trigger
your chest pain to start.Such as eating a spicy meal. Your chest pain may even
come and go for no reason that you know of. Some chest pain may return often
and be bothersome to you, but it may not be dangerous. However, some chest
pain may be a sign of a serious (very bad) health condition. You may not know
what is causing your chest pain until you are seen at a hospital or clinic. Some
causes of chest pain include the following.

Blood or circulation problems

Anxiety, depression, or panic attacks
Bone, nerve, or muscle problems
Heart (cardiac) problems (life threatening)
Lung problems
Digestive tract problems
Other problems
Blood or circulation problems: High blood pressure or anemia (iron-poor blood)
may cause chest pain. Another cause may be an aneurysm, which is a weak part in an
artery (blood vessel) wall. Aneurysms can be serious, even life threatening.
Atherosclerosis or "hardening of the arteries," may cause chest pain. Atherosclerosis is
a disease that causes fatty deposits to narrow arteries in your body, and increase your
risk of blood clots.

Anxiety, depression, or panic attacks: Panic attacks may cause chest pain that feels
like you have a serious health problem, even though it is not life threatening.
Hyperventilation (breathing too fast) can also cause bad chest pain. People who have
depression (feeling sad most or all of the time) may have chest pain or heaviness.

Bone, nerve, or muscle problems: Examples include arthritis and other

inflammation (swelling) problems, hard coughing, and overdoing exercise. Herpes
zoster (shingles) can cause chest pain. Injuries, such as after a car accident or a blow to
the chest may also cause chest pain.
Heart (cardiac) problems: Chest pain because of a heart problem may be serious
(life threatening) and requires emergency medical care. Only a medical caregiver can
say for sure if your chest pain is caused by a heart problem or not.

Almost any heart problem can cause chest pain. For example, heart valve problems,
heart rhythm problems, heart enlargement, and heart failure can cause chest pain.

Angina is chest pain that happens when the heart does not get enough oxygen to do its
work. You may have angina because of atherosclerosis or other heart problems. If the
heart goes too long without enough oxygen, part of the heart muscle may die. This is
called a myocardial infarction, "MI", or a heart attack. Angina can be a warning sign
that you may be at risk for a heart attack.
Lung problems: Examples include infections (such as bronchitis), or inflammation
(swelling) in or around a lung. A blood clot in a lung or lung diseases may cause chest
pain. Breathing in smoke or fumes can cause chest pain.

Digestive tract problems: Acid reflux, ulcers, or other stomach and esophagus (food
pipe) problems may cause chest pain. Problems with too much gas in your stomach or
intestines, or other digestion problems may cause chest pain. Gallbladder or pancreas
problems may also cause chest pain.
Other problems: Taking illegal (street) drugs, such as cocaine, or
misusing certain medicines may cause chest pain. Certain diseases such as
lupus may cause chest pain. Tumors (growths) in your chest or abdomen
may cause chest pain. Problems with almost any organ in your chest or
abdomen may cause chest pain.
From Hurst
 PE

Non Cardiac PTX

Esophageal disaster

Chest Pain Coronary spasm

Aortic disease

Obstructive CAD

Cardiac Myo/pericardium
Stable angina

Coronary disease
ACS
 Accumilation of liquids in the lungs (Multiple
Reason)

Resultant : Will cause failure of successful

exchange of gases through the lungs. Alter
breathing rate. Coughing blood, Pale skin,
excessive sweating and Pink sputum
(caughing saliva).
Pneumothorax is the presence of air in the
chest cavity.

Causes:
◦ Smoking.
◦ Trauma.
◦ Surgical procedures.
◦ Ext.
Resultant
◦ Usually 20s-40s, present with sudden onset
dyspnea(SOB) and chest pain at rest.
◦ Hypoxeima (Less blood oxygen level) common.
 PE

Non Cardiac PTX

Esophageal disaster

Chest Pain Coronary spasm

Aortic disease

Obstructive CAD

Cardiac Myo/pericardium
Stable angina

Coronary disease
ACS
 Traumatic: MVA, chest wall trauma
 Spontaneous: (transmural perforation)

◦ Vomiting (Boerhaave’s Syndrome): retching

followed by severe chest and epigastric pain,
tachypnea, dyspnea, fever, cyanosis, shock
◦ Caustic ingestion, pill esophagitis, Barrett’s,
esophageal ulcers in HIV patients
 Sharp, “tearing” anterior or posterior chest
and back pain.
 Typically sudden onset and severe
 Chest pain more common with type A

dissections
 Complicated by CVA, syncope, MI (RCA) or HF
 PE

Non Cardiac PTX

Esophageal disaster

Chest Pain Coronary spasm

Aortic disease

Obstructive CAD

Cardiac Myo/pericardium
Stable angina

Coronary disease
ACS
 Sharp, “tearing” anterior or posterior chest
and back pain.
 Typically sudden onset and severe
 Chest pain more common with type A

dissections
 Complicated by CVA, syncope, MI (RCA) or HF
 Unstable Angina
◦ Rest angina: Usually >20 minutes duration
◦ New onset severe angina
◦ Increasing angina
 Initial therapy: Oxygen, nitro, ASA, ECG
 Heart Rate control
 Antiplatelets: Clopidogrel, Prasugrel
 Anticoagulation:
 Pain control:
 Conservative vs. Invasive management