Chest pain 545918 225670960 2008-07-14T20:48:20Z Dilbert08 366546 /* Cardiopulmonary */ {{SignSymptom infobox | Name = Chest pain | ICD10 = {{ICD10|R|07||r|00}} | ICD9 = {{ICD9|786.5}} }}In [[medicine]], '''chest pain''' is a [[symptom]] of a number of serious conditions and is generally considered a [[medical emergency]], unless the patient is a known [[angina pectoris]] sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as "stable angina"). When the chest pain is not attributed to heart disease, it is termed '''non-cardiac chest pain.''' ==Causes== ===Cardiopulmonary=== Important [[cardiovascular disease|cardiovascular]] and [[pulmonology|pulmonary]] causes of ''chest pain'': * "Stable" [[Angina Pectoris]] - this can be treated medically and although it warrants investigation, it is not an emergency in its strictest sense * [[Acute coronary syndrome]] ** "Unstable" [[Angina Pectoris]] - requiring emergency medical treatment but not primary intervention as in a myocardial infarction ** [[Myocardial infarction]] ("heart attack") * [[Aortic dissection]] * [[Pulmonary embolism]] * [[Pneumonia]] * [[Hemothorax]] * [[Pneumothorax]] and [[Tension pneumothorax]] * [[Cardiac arrhythmia|Arrhythmia]] - [[atrial fibrillation]] and a number of other arrhythmias can cause chest pain. ===Other causes=== Other causes of chest pain include: * Prolong Exposure to Carbon Monoxide (see [[Carbon Monoxide Poisoning]]) *[[Lead Poisoning]] * Upper gastrointestinal ailments, for example: ** [[gastroesophageal reflux disease]] (GERD) and other causes of [[heartburn]] ** [[Hiatus hernia]] (which may not accompany GERD) ** [[Achalasia]], [[nutcracker esophagus]] and other neuromuscular disorders of the [[esophagus]] * Functional Dyspepsia * Problems of outer chest structures ** [[Tietze's syndrome]] - a benign and harmless form of osteochondritis often mistaken for heart disease, often called costochondritis ** [[Spinal nerve]] problem ** [[Fibromyalgia]] ** [[Thoracic cavity|Chest wall]] problems and [[breast]] conditions ** [[Herpes zoster]] commonly known as shingles *Psychological ** [[Panic attack]] ** [[Anxiety]] ** [[Clinical depression]] ** [[Somatization disorder]] ** [[Hypochondria]] * Others ** [[Hyperventilation syndrome]] often presents with chest pain and a tingling sensation of the fingertips and around the mouth ** [[Da costa's syndrome]] ** [[Bornholm disease]] - a [[virus|viral]] disease that can mimic many other conditions ** [[Precordial catch syndrome]] - another benign and harmless form of a sharp, localised chest pain often mistaken for heart disease ** [[Pleurisy]] - an inflammation which can cause painful respiration High [[abdominal pain]] may also mimick chest pain. ==Analysis== As in all medicine, a careful medical history and physical examination is essential in separating dangerous and trivial causes of disease, and the management of chest pain is often done on specialised units (termed ''medical assessment units'') to concentrate the investigations. A rapid diagnosis can be life-saving and often has to be made without the help of [[X-ray]]s or [[blood test]]s (e.g. [[aortic dissection]]). Occasionally, invisible medical signs will direct the diagnosis towards particular causes, such as [[Levine's sign]] in cardiac ischemia. Generally, however, additional tests are required to establish the diagnosis. An [[emergency medicine]] doctor will also focus on recent health changes, family history (premature [[atherosclerosis]], [[cholesterol]] disorders), [[tobacco smoking]], [[diabetes]] and other risk factors. Features of the pain suggest of cardiac ischaemia are describing the pain as heaviness; radiation of the pain to neck, jaw or left arm; sweating; nausea; palpitations; the pain coming upon exertion; dizziness; shortness of breath and a "sense of impending doom." On the basis of the above, a number of tests may be ordered: * [[X-ray]]s of the chest and/or abdomen ([[Computed tomography|CT scanning]] may be better but is often not available) * An [[electrocardiogram]] (ECG) * [[Ventilation/perfusion scan|V/Q scintigraphy]] or [[CT pulmonary angiogram]](when a [[pulmonary embolism]] is suspected) * [[Blood test]]s: ** [[Complete blood count]] ** [[Electrolyte]]s and [[renal function]] ([[creatinine]]) ** [[Liver function tests|Liver enzyme]]s ** [[Creatine kinase]] (and ''CK-MB'' fraction in many hospitals) ** [[Troponin]] I or T (to indicate [[myocardium|myocardial]] damage) ** [[D-dimer]] (when suspicion for [[pulmonary embolism]] is present but low) ** [[serum amylase]] to exclude acute pancreatitis ==Interpretation== In finding the cause, the history given by the patient is often the most important tool. In [[angina pectoris]], for example, blood tests and other analyses are not sensitive enough (Chun & McGee 2004). The physician's typical approach is to rule-out the most dangerous causes of chest pain first (e.g., heart attack, blood clot in the lung, aneurysm). By sequential elimination or confirmation from the most serious to the least serious causes, a diagnosis of the origin of the pain is eventually made. Often, no definite cause will be found, and the focus in these cases is on excluding severe diseases and reassuring the patient. If [[acute coronary syndrome]] ("unstable angina") is suspected, many patients are admitted briefly for observation, sequential ECGs, and determination of cardiac enzyme levels over time ([[creatine kinase|CK-MB]], [[troponin]] or [[myoglobin]]). On occasion, later out-patient testing may be necessary to follow-up and make better determinations on causes and therapies. ==References== <small> * {{cite journal | author = Chun A, McGee S | title = Bedside diagnosis of coronary artery disease: a systematic review | journal = Am J Med | volume = 117 | issue = 5 | pages = 334–43 | year = 2004 | pmid = 15336583 | doi = 10.1016/j.amjmed.2004.03.021}} * {{cite journal | author = Ringstrom E, Freedman J | title = Approach to undifferentiated chest pain in the emergency department: a review of recent medical literature and published practice guidelines | journal = Mt Sinai J Med | volume = 73 | issue = 2 | pages = 499–505 | year = 2006 | pmid = 16568192}} ''[http://www.mssm.edu/msjournal/73/73_2_pages_499_505.pdf Full text (PDF)]'' * {{cite journal | author = Butler K, Swencki S | title = Chest pain: a clinical assessment | journal = Radiol Clin North Am | volume = 44 | issue = 2 | pages = 165–79, vii | year = 2006 | pmid = 16500201 | doi = 10.1016/j.rcl.2005.11.002}} * {{cite journal | author = Haro L, Decker W, Boie E, Wright R | title = Initial approach to the patient who has chest pain | journal = Cardiol Clin | volume = 24 | issue = 1 | pages = 1–17, v | year = 2006 | pmid = 16326253 | doi = 10.1016/j.ccl.2005.09.007}} * {{cite journal | author = Fox M, Forgacs I | title = Unexplained (non-cardiac) chest pain | journal = Clin Med | volume = 6 | issue = 5 | pages = 445–9 | year = 2006 | pmid = 17080889}}</small> ==External links== * [http://www.emedicinehealth.com/articles/27608-1.asp Wilderness Medicine: Chest Pain] - eMedicineHealth.com *[http://anginapectorisonline.com Angina Pectoris Online] Chest pain resource for nurses and those in similar professions. * [http://www.bhf.org.uk/Doubtkills/download_our_podcast.aspx British Heart Foundation] - Podcast on chest pains and heart attacks. {{Pain}} {{Circulatory and respiratory system symptoms and signs}} [[Category:Symptoms]] [[Category:Cardiology]] [[fr:Douleur thoracique]] [[it:Dolore toracico]] [[pl:Ból w klatce piersiowej]] [[pt:Dor torácica]] [[uk:Біль за грудиною]] [[ur:سینے کا درد]] [[yi:טשעסט פעין]]