- This is my first article corcerning medical information although I’m now second year medical student at Cairo University.This was not because I didn’t want to share anything about it but admitting my knowledge limit about medicine had stopped my intention to do that.However,after I read the article ‘Hinakah Bersama PERUBATAN?’ posted by akhi Hafiz Adam,it changes my mind.There’s some points in this article that I agree especially when he said that almost medical students’ blogs not contain any medical articles.Lots of them only posted articles about religion,criticism,story and many more.But,I also didn’t agree with some points stated by him.
- Therefore,I have taken decision from now to post anything about medical information every Tuesday,insya ALLAH.I choose to post them in English because most of these information are in English as well as to enhance my English improvement.At this time I will focus on the famous disease and problem in health among the people.I hope many of us will try to share or even write by ourselves about medicine particularly fourth year medical students and above after this.This week,I would like to share with you about Chest Pain.
Chest pain is one of the most common complaints that will bring a patient to the Emergency Department. Seeking immediate care may be lifesaving, and considerable public education has been undertaken to get patients to access medical care when chest pain strikes. While the patient may be worried about a heart attack, there are many other causes of pain in the chest that the healthcare provider will need to consider. Some diagnoses are life threatening, while others are less dangerous.
Deciding the cause of chest pain is sometimes very difficult and may require blood tests, x-rays, CT scansand other tests to sort out the diagnosis. Often though, a careful history taken by the healthcare provider may be all that is needed to find the answer.
What are the sources of chest pain?
The source of pain may arise from a variety of potential sources:
- the chest wall including the ribs, the muscles, and the skin;
- the back including the spine, the nerves, and the back muscles;
- the lung, the pleura (the lining of the lung) or the trachea;
- the heart including the pericardium (the sac that surrounds the heart);
- the aorta;
- the esophagus;
- the diaphragm, the flat muscle that separates the chest and abdominal cavities;
- referred pain from abdominal organs like the stomach, gallbladder, and pancreas.
While each source of chest pain may have a classic presentation of signs and symptoms, there is significant overlap among the symptoms of each condition, and the symptoms may also be affected by age, gender and race.
What are the causes of chest pain?
Pain can be caused by almost every structure in the chest. Different organs can produce different types of pain but unfortunately the pain is not specific to each cause. Each of the following causes is explained in detail in this article:
- Broken or bruised ribs
- Pleuritis or pleurisy
- Pulmonary embolus
- Heart attack (myocardial infarction)
- The aorta and aortic dissection
- The esophagus and reflux esophagitis
- Referred abdominal pain
How is chest pain diagnosed?
The key to diagnosis remains history. Learning about the nature of the pain will give the healthcare provider direction as to what are reasonable diagnoses to consider, and what are reasonable to exclude. Understanding the quality and quantity of the pain, its associated symptoms and the risk factors for disease, can help the care provider assess the probability of what potential diagnoses should be considered and which should be discarded.
Differential diagnosis is a thought process that healthcare providers use to consider and then eliminate potential causes for an illness. As more information is gathered, either from history and physical examination or testing, the potential diagnosis list is narrowed until the final answer is achieved. As well, the patient’s response to therapy can expand or narrow the differential diagnosis list. In patients with chest pain, many potential diagnoses may exist, and the healthcare provider will want to first consider those that are life-threatening. Tests to rule out heart attack, pulmonary embolus, or aortic dissection may not be necessary; when clinical skill and judgment may be all that is needed to consider or discard a diagnosis.
The patient may be asked a variety of questions to help the healthcare provider understand the patient’s pain. Patients use different words to describe pain, and it is important that the healthcare provider get an accurate impression of the situation. The questions may also be asked in different ways.
Questions the doctor may ask about chest pain
- When did the pain start?
- What is the quality of the pain?
- How long does the pain last?
- Does the pain come and go?
- What makes the pain better?
- What makes the pain worse?
- Does the pain radiate somewhere (move to another area of the body)?
- Has there been any preceding illness?
- Has there been any trauma?
- Have there been similar episodes of pain in the past?
Questions about the associated symptoms
Questions about risk factors for disease
Risk factors for heart disease
Risk factors for pulmonary embolus (blood clot to the lung)
- Prolonged inactivity such as bed rest, long car or airplane trips
- Recent surgery
- Birth control pill use (particularly if the patient smokes cigarettes)
Risk factors for aortic dissection
- High blood pressure
- Marfan syndrome
- Ehlers-Danlos syndrome
- Polycystic kidney disease
- Cocaine use
Physical examination helps refine the differential diagnosis. While chest pain may be the initial complaint, often the whole body needs to be examined. Example components of the physical exam may include:
- Blood pressure (BP), pulse rate (PR), respiratory rate (RR), temperature, and
- Oxygen saturation (O2 sat)
Head and neck
- Looking for neck vein distension or bulging
- Listening over the carotid arteries for bruits (abnormal sounds) or murmurs
- Palpate for rib or muscle tenderness
- Look for rashes
- Listen for abnormal lung sounds or decreased air entry
- Listen for abnormal heart sounds, murmurs or rubs (a friction sound made by two rough surfaces rubbing against each other, which may be seen with inflammation of the heart lining, called pericarditis)
- Listen for muffled heart tones
- Palpate for tenderness or masses
- Listen for bruits over the aorta
- Feel for pulses