Chest pain Causes, Hystory


Doctor Alina Laura Dumitrascu


Chest Pain Causes
Heart Attack Causes
A heart attack is caused by coronary heart disease, or coronary artery disease. Heart disease may be caused by cholesterol buildup in the coronary arteries (atherosclerosis), blood clots, or spasm of the vessels that supply blood to the heart. Risk factors for a heart attack are: • high blood pressure • diabetes • smoking • high cholesterol • family history of heart attacks at ages younger than 60 years, one or more previous heart attacks, male gender • Obesity • Postmenopausal women are at higher risk than premenopausal women. This is thought to be due to loss of the protective effects of the hormone estrogen at menopause. It was previously treated by hormone supplements (hormone replacement therapy, or HRT). However, research findings have changed our thinking on HRT; long-term HRT is no longer recommended for most women. • Use of cocaine and similar stimulants.

or by certain heart rhythm disorders (arrhythmias) that cause the heart to beat very fast. Angina can be triggered by exercise or physical exertion. narrowing. or partial blockage of an artery that supplies blood to the heart.Chest Pain Causes Angina Causes Angina may be caused by spasm. by emotional stress. . in which a blood clot or buildup of fatty material inside the blood vessel (atherosclerosis) reduces blood flow but does not completely block the blood vessel. The most common cause is coronary heart disease.

cocaine use. Aneurysms can occur in the aorta in the chest or the abdomen. Men are at higher risk than women. causing pain and bleeding. uncontrolled high blood pressure. .Chest Pain Causes Aortic Dissection Causes •Aortic dissection may be caused by conditions that damage the innermost lining of the aorta: • • • • • • • connective-tissue diseases. advanced age. This is an enlargement of the aorta that can rupture. pregnancy. A similar condition is aortic aneurysm. cardiac catheterization (a medical procedure). congenital heart disease.

cancer. heart attack. irregular heartbeat (arrhythmias). obesity. Women who use birth control pills and smoke cigarettes are at higher risk than women who have only one or neither of these risk factors (especially over the age of 35). prolonged immobility. fracture of a long bone of the legs. history or family history of blood clots. or congestive heart failure. pregnancy. .Chest Pain Causes Pulmonary Embolism Causes Pulmonary embolismrisk factors include: sedentary lifestyle.

cancer. gunshot wound or stabbing.Chest Pain Causes Spontaneous Pneumothorax Causes Spontaneous pneumothorax (collapsed lung) occurs when the pressure balance between the sac that contains the lung and the outside atmosphere is disrupted. severe asthma. It is possible for these abnormal air sacs to rupture with even a sneeze or excessive coughing. as in a car wreck. Other risk factors for pneumothorax include AIDS-related pneumonia. Some very thin and tall people may suffer a spontaneous pneumothorax due to stretched lung tissues and abnormal air sacs in the upper portions of their lungs. This can be caused by trauma. emphysema. and marijuana and crack cocaine use . Injury to the chest that pierces through to the lung sac is the most common cause of this condition. bad fall. or in surgery. cystic fibrosis.

appendicitis. The diaphragm is the muscle that allows us to breathe. cancer. AIDS. prolonged or forceful vomiting. even from below it. gallstones. It is located up under the ribs and separates the chest and abdominal cavity. Any irritation to the diaphragm. infection of the gallbladder. swallowing a foreign body. .Chest Pain Causes Perforated Viscus Causes Perforated viscus may be caused by direct or indirect injury. Irritation to the diaphragm in this case comes from below the chest. can cause pain to be felt in the chest. Risk factors not related to trauma are: untreated ulcers. long-term steroid use.

Symptoms of cardiac tamponade include sudden onset of shortness of breath. certain medications. and chest pain. and chronic renal failure.Chest Pain Causes Pericarditis Causes Pericarditis can be caused by viral infection. radiation treatment. fainting. . bacterial infection. This prevents the heart from effectively pumping blood to the body. One life-threatening complication of pericarditis is cardiac tamponade. cancer. connective-tissue diseases. Cardiac tamponade is an accumulation of fluid around the heart.

.Chest Pain Causes Esophagus Related Causes Chest pain originating from the esophagus may have several causes. decreased movement of the esophagus. Spasm may be triggered by emotional upset or swallowing very hot or cold liquids. viruses. or uncoordinated contractions of the smooth muscle of the esophagus. bacteria. Acid reflux (GERD) may be caused by any factors that decrease the pressure on the lower part of the esophagus. Esophagitis may be caused by yeast. or irritation from medications. fungi. Esophageal spasm is caused by excessive. intensified. or prolonged emptying of the stomach.

movement. The pain may precede the rash by 4-7 days.Chest Pain Causes Pneumonia Causes Pneumonia may be caused by viral. is usually confined to the area of the rash. HIV. . or fungal infections of the lungs Costochondritis: This is an inflammation of the cartilage between the ribs. or cancer. this is a reactivation of the viral infection that causes chickenpox. With shingles. The pain. Risk factors include any condition in which the immune systemis compromised. usually only on one small part of the body. with intermittently dull and sharp pain that may be increased with deep breaths. Herpes zoster is highly contagious to people who have not had chickenpox or have not been vaccinated against chickenpox for the five days before and the five days after the appearance of the rash. Pain is typically located in the midchest. often very severe. such as advanced age. Herpes zoster: Also known as shingles. bacterial. and deep touch. a rash occurs.

Chest Pain Characteristics to Ask and Document • Quality—crushing. knifelike… • Intensity—1-10 scale • Character—sudden. burning. gradual • Duration—in minutes or hours • Radiation—to back. legs. neck? • Influencing factors—anything make it better or worse? • Associations—any associated symptoms? .

Other Symptoms That = Consider ACS • Syncope. AMS • Nausea/Vomiting • Weakness • Diaphoresis • Shortness of Breath . Presyncope.

Variables for Risk Stratification • Characteristics of Chest Pain and associated symptoms • Past History of Coronary Disease • Risk Factors • ECG • Enzymes .

Weakness . stabbing.Nausea • Radiation to back.Diaphoresis • Lasting 15-30 minutes Chest Pain is the hallmark of AMI • Made better by rest. greater than 48 hours • Crushing Substernal • Pain reproduced by palpation • Radiating to the left arm and/or jaw • Stabbing Pain • Associated with: • Age less than 40 .The History Classic Ischemic Chest Pain Atypical Stuff • C.P. abdomen . legs. worse by but exertion • May be absent • May be fleeting • May be different than substernal may be: • Pleuritic. or even palpable .

Atypical Stuff .Probability of AMI in 6000 pts NEJM 1994 Chest 1992 • C.P. greater than 48 hours New ST No New ST • Pain reproduced by palpation • Stabbing Pain • Age less than 40 • Radiation to back. legs. abdomen 20% 1% 1% 3% 2% 1% .

50% age 80) • Chest Pain Infrequent above age 85 (38% above age 85) • Beware “Atypical” presentation .P. ages 65-100 • Chest pain was seen in only 66% • Frequency of C.“ Atypical” Presentations In the Elderly J AM Geriatr Soc 1986 • 777 AMI’s. decreases with age (75% age 70.

“Typical” Symptoms of AMI in the Elderly J AM Geriatr Soc 1986 • Dyspnea 40% • Syncope 14% • AMS 7% • Weakness 7% • Giddiness 5% • Stroke 4.5% Beware Dyspnea in the Elderly ! .

Details in CP History • Quality • Location • Radiation • Size of Area • Severity • Time of Onset • Duration • First Occurrence • • • • • • • • Pleuritic Positional Palpable Exercise Emotional Stress Relieving Factors Associated Symptoms Similarity to Prior ACS .

. ¼ of us ask 0-1 of the questions… Because the aorta supplies blood to the entire body. shortness of breath. you will pick up 90% of Dissection.Aortic Dissection Symptoms You Must Ask and Document This in All Chest Pain Patients • Was it: .tearing or ripping? . symptoms may also include: angina-type pain. abdominal pain.start at maximal intensity? -Radiate to back. abdomen and legs? If you ask all 3. Fainting. or symptoms of stroke.

rapid breathing. . which increases with deep breaths.Pulmonary Embolism Symptoms Symptoms of a pulmonary embolus include: the sudden onset of shortness of breath. and sharp pain in the mid chest.

rapid heart rate. sharp chest pain.Pneumothorax Symptoms Symptoms of pneumothorax include: the sudden onset of shortness of breath. or faintness. . dizziness. lightheadedness.

and/or back pain.Perforated Viscus Symptoms Perforated viscus comes on suddenly with severe abdominal. boardlike abdominal wall. . Abdominal pain may increase with movement or when breathing in and may be accompanied by a rigid. chest.

there is a space between the pericardium and the heart.Pericarditis Symptoms The pain of pericarditis is typically described as a sharp or stabbing pain in the mid-chest. When leaning forward. worsened by deep breaths. . or pain when swallowing just before developing pericarditis. because it may radiate to the left side of the back or shoulder. the inflamed pericardium is in direct contact with the heart and causes pain. When lying flat. One distinguishing factor is that the pain is worsened by lying flat and improved by leaning forward. Many people report a recent cold. This pain may mimic the pain of a heart attack. fever. shortness of breath.

coughing up mucus (sputum). .Pneumonia Symptoms The chest pain of pneumonia occurs during prolonged or forceful coughing. Other associated symptoms include fever. The pain is usually one-sided an is worsened by coughing. and shortness of breath.

dull chest discomfort. It is located in the mid-chest and may radiate to the back. Symptoms of gastroesophageal reflux disease (GERD) include: heartburn. Pain from GERD is often relieved with antacids Symptoms of esophagitis include difficulty swallowing. or severe squeezing pain across the mid chest. painful swallowing. symptoms depend on the source. or symptoms of GERD. painful swallowing. neck. chest pressure. . excessive salivation. or shoulders. The pain of esophageal spasm is usually intermittent and dull.Esophagus Related Symptoms With chest pain originating from the esophagus. The chest pain comes on suddenly and is not relieved by antacids.

000. about 1-2 in 100 AMI patients are discharged from hospitals by competent physicians. In general. . If we appreciate that it could happen to any of us and try to study how we miss AMI’s.“No single element of the Chest Pain History is a powerful enough predictor of non-ACS or non-AMI to allow clinicians to make decisions according to it alone” JAMA 2005 Atypical is Typical One missed AMI will change your life and your patient’s life Forever Missing an AMI is a common event. then maybe we can make our miss rate 1 in 1000 or 1 in 10.

This talk’s goal is for you to never miss an AMI or discharge a chest pain patient (or anginal equivalent) who has an acute coronary syndrome. .

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