CHEST PAIN

DEFINITION
A General term for any dull, aching
pain in the Thorax. It can be
Cardiac or Non Cardiac related

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DD OF CHEST PAIN
Ches pain

Central Peripheral

Cardiac Non Cardiac Pulmonary Non Pulmonary

IHD (Angina / Pulmonary

Infarction Herpes zoster
Infarction) Embolism

Coronary artery Oesophageal Bormholm

Pneumonia
Spasm Disease Disease

Pericarditis/
Costochondritis Pneumothorax Trauma
Myocarditis

Mitral valve
Trauma Lung cancer
Prolapse

Aortic
Aneurism/ Mesothelioma
Dissection

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 ANGINA

• -intermittent chest pain caused by transient, reversible myocardial ischaemia

• - ischaemic metabolites , stimulate nerve endings and produce pain

• - retrpsternal heavy or gripping sensation

• - radiates to left arm and neck
• - increased with exertion
• - ease with rest or nitrates

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 ACUTE CORONARY SYNDROME

- rupture or erosion of the fibrous cap of a coronary artery plaque

- cause platelet aggregation>localized thrombus> vasoconstriction> distal thrombus
embolization
- 3 types
STEMI, NSTEMI , Unstable angina

- heavy or gripping type pain

- radiate to left arm or jaw
- pain at rest

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 DIFFERENCE BETWEEN STEMI , NSTEMI , UA

- STEMI - ST segment elevation in ecg

- in UA and NSTEMI,
NSTEMI there is an ocluding thrombus cause myocardial necrosis and rise in serum troponin and
creatine kinase level

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 PERICARDITIS

• Primary pericarditis is uncommon. It most often is due to viral

infection.
• In most cases, pericarditis is secondary to acute MI, cardiac
surgery, radiation to the mediastinum, Uremia.
• Chest pain in pericarditis exacerbated by movement and
relieved by sitting forward.

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 AORTIC DISSECTION

• occurs when blood splays apart the laminar planes of the tunica media to
form a blood-filled channel within the aortic wall.
• Hypertension, Marfan syndrome, Ehlers-Danlos syndrome are the risk
factors for aortic dissection.
• sudden onset of excruciating tearing or stabbing pain, usually beginning in
the anterior chest, radiating to the back between the scapulae.

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 PULMONARY EMBOLISM

• Blood clots that occlude the large pulmonary arteries are almost always
embolic in origin. Most of pulmonary emboli arise from thrombi within
the large deep veins of the lower legs.
• Sudden onset
• Pleuritic type chest pain
• Tachypnoea, haemoptysis
• Previous hx of DVT, long term immobilization following sugery

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 PNEUMONIA
• Pneumonia is an infection that inflames the air sacs in one or both lungs.
The air sacs may fill with fluid or pus (purulent material), causing cough
with phlegm or pus, fever, chills, and difficulty breathing.
• Pleuritic pain
• Aggravated with breathing, cough
• Productive cough
• Fever
• Wheezing
• Haemoptysis

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 GORD

• Gastro-oesophageal reflux disease (GORD) is a common

condition, where acid from the stomach leaks up into the
oesophagus (gullet).
• GORD o Retrosternal burninng pain
• At night or bending forward
• Belching, burping, heart burn, regurgitation of food
• Cough due to laryngeal irritation
• Risk factors- dairy products, fatty meals, chocolate, coffee,
smoking, alcohol, NSAIDs

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THANK YOU

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