ملخص

Chest pain

Chest pain is a common presentation of cardiac disease, but can also be a manifestation of other causes .
COMMON CAUSES OF CHEST PAIN
Cardiac
Aortic
Aortic dissection
Oesophageal
Oesophagitis
Lungs/pleura
Bronchospasm , pleuritis
Musculoskeletal
Osteoarthritis
Rib fracture/injury
Neurological
Herpes zoster
Psychogenic/Anxiety






Pattern of onset. The pain of myocardial infarction typically takes several minutes or even longer to develop; similarly, in proportion to the intensity of exertion. Pain that occurs after exertion is usually musculoskeletal or psychological in origin. The pain of aortic dissection, massive pulmonary embolism or pneumothorax is usually very sudden or instantaneous in onset.
Associated features. The pain of myocardial infarction, massive pulmonary embolism or aortic dissection is often accompanied by autonomic disturbance including sweating, nausea and vomiting.

Breathlessness may also accompany any of the respiratory causes of chest pain

Classical gastrointestinal symptoms (oesophageal reflux, oesophagitis, peptic ulceration or biliary disease) may provide the clue to the source of non-cardiac chest pain

Myocardial infraction

1-more than 30min
2-may occur at rest
3- not relieved by nitrate
4- associated feature breathlessness , nausea , sweating
5-more sever pain
6-due to occlusion of the vessel
Angina
1-pain less than 5min
2-precepiated by exertion
3- relieved by nitrate
4-associated feature breathlessness
5-less sever pain
6-due to narrowing of vessel


Myocarditis and pericarditis cause pain that is characteristically felt retrosternally, to the left of the sternum, or in the left or right shoulder, varies in intensity with movement and the phase of respiration. The pain is usually described as 'sharp' and may 'catch' the patient during inspiration
Mitral valve prolapse Sharp left-sided chest pain that is suggestive of a musculoskeletal problem may be a feature of mitral valve
Aortic dissection This pain is severe, sharp and tearing, often felt in or penetrating through to the back, and is typically very abrupt in onset
Oesophageal pain Oesophageal pain can mimic that of angina very closely, is sometimes precipitated by exercise and may be relieved by nitrates
Bronchospasm Patients with reversible airways obstruction, such as asthma, may describe exertional chest tightness that is relieved by rest
Musculoskeletal chest pain
The pain may vary with posture or movement of the upper body and is sometimes accompanied by local tenderness over a rib or costal cartilage.