Cardiovascular

Chest pain is one of the common complaints heard in medical OPDs as well as at the
GPs clinic. Chest pain causes a lot of anxiety in the patient as it is many a time related to
heart attack or angina and people are quite aware of the serious consequences of the
symptom. Anyone having a chest pain would first think of the heart and would like to know if
he/she is having a heart attack.
However not all times is a chest pain necessarily originating from or caused by
diseases of the heart. There are plenty of other structures in the thoracic cavity and a
systematic approach is needed to arrive at the correct diagnosis or in other words to find out
the real culprit causing the chest pain.
Of special importance is the issue of chest pain in women, as this group is less liable
to get heart disease till menopause. Estrogen is said to confer a protective effect and prevents
the development of atherosclerosis. Myocardial infarction or Coronary artery disease (CAD)
is very rare in menstruating women. As menopause approaches and estrogen levels go down,
the probability of development of CAD catches up with those in men.
Even then, there are lots of young to middle aged, menstruating women complaining
of chest pain and quite distressed about it. Before I highlight the special features of this
particular issue lets first review the differential diagnosis of chest pain.

Differential Diagnosis of Chest Pain

1. Angina Pectoris/Myocardial Friday 26th May, 2006
Infarction
2. Other Cardiovascular Causes
a. Possibly Ischemic Pain

1) Aortic Stenosis
2) Hypertrophic Cardiomyopathy
3) Severe Systemic Hypertension
4) Severe Right Ventricular Hypertension
5) Aortic Regurgitation
6) Severe Anemia/hypoxia

b. Non Ischemic in Origin

1) Aortic Dissection
2) Pericarditis
3) Mitral Valve Prolapse

3. Gastrointestinal
a. Esophageal Spasm
b. Esophageal Reflux
c. Esophageal Rupture
d. Peptic Ulcer Disease
4. Psychogenic
a. Anxiety
b. Depression
c. Cardiac Psychosis
d. Self Gain

5. Neuromusculoskeletal
a. Thoracic Outlet syndrome
b. Lesions of Cervical/Thoracic Spine
c. Costochondritis[Tietzes Syndrome]
d. Herpes Zoster
e. Chest wall pain

6. Pulmonary
a. Pulmonary Embolus/Infarction
b. Pneumothorax
c. Pneumonia with pleural involvement

7. Pleurisy
As most patients are anxious of their chest pain being that of Heart origin, we shall
first have a look at the features of Cardiac Pain.