Don't ignore chest pain
Dr MA Razaque *
Pain in acute myocardial infarction (front) :: Pix - JHeuser/Wikipedia
WHAT IS PAIN?
Pain is a subjective, unpleasant, sensory and emotional experience associated with actual or potential tissue damage. Pain is an integral part of ordinary daily life. The pain varies from person to person in its quality, duration, location, frequency and associated symptoms. The perception of pain also may vary according to socio-economic status, cultural background, psychological factors and previous pain experience.
Pain which is transient is one of the most common features of daily life. But persistent pain may cause substantial distress, impairment of lifestyle and inability to meet social obligations.
TYPES OF CHEST PAIN:
Chest pain is one of the symptoms which compel the sufferer to seek medical advice. Chest pain is particularly important because it may herald the presence of severe or life-threatening disease. Chest pain is one of the most common symptoms of heart diseases. However non-cardiac diseases may also cause chest pain.
Chest pain may be typical or a typical. "Typical" chest pain is the pain that is typical of angina pain and is usually described as substernal (behind the breast bone) pain radiating to left side of neck/jaw and left arm and is pressure-like or has a squeezing sensation. "Atypical" chest pain is defined as the absence of this type of typical presentation. However, atypical chest pain does not rule out cardiac cause. Chest pain may also be acute, chronic or recurrent.
CAUSES OF CHEST PAIN:
Chest pain may be caused by many cardiac and non-cardiac diseases. Some of the common causes are given below:
1. Cardiac causes:
a. Angina
b. Myocardial infarction
c. Periccarditis
d. Aortic dissection ,etc
2. Non-cardiac causes:
a. Pneumonia
b. Pleuritis with or without pleural effusion
c. Pulmonary embolism
d. Pneumothorax
e. Lung cancer
3. Gastro-intestinal:
a. Oesophageal spasm
b. Oesophagitis
c. Gastritis/peptic ulcer disease
d. Gall bladder stone
e. Pancreatitis
4. Musculo-skeletal:
a. Costochondritis
b. Rib fracture
c. Muscle spasm
5. Neurologic:
a. Herpes zoster
b. Nerve root compression
6. Psychogenic:
CHARACTERISTICS OF CHEST PAIN:
It is important to have a clear idea of what the pain is like, because, the cause of the chest pain may be indicated by the characteristics of the pain such as:
1. Onset off pain e.g. sudden or insidious etc.
2. Location of pain e.g. Central (substernal), peripheral or diffuse, on the back between the scapulae
3. Radiation of pain: e.g. neck, jaw, arm
4. Frequency of pain e.g. intermittent or constant.
5. Duration of pain e.g. seconds, minutes, hours or days
6. Type of pain e.g. Burning, squeezing, tearing, sharp, dull or heavy, etc
7. Precipitating/aggravating factors e.g. Stress, exertion, food, movement or respiration.
8. Relieving factors e.g. rest or drugs, etc
9. Associated symptoms e.g. breathlessness, sweating, palpitation, nausea, vomiting, cough, haemoptysis, fever, etc
10. Presence of risk factors e.g. smoking, diabetes, hypertension, hyperlipidaemia, family history of heart diseases etc.
INVESTIGATIONS:
The following investigations/tests may be required to find out the origin of the chest pain:
1. Blood test for CBC, CK-MB, troponin, D-dimer, lipids, blood sugar, LFT, thyroid function test etc.
2. Chest x-ray
3. ECG
4. Echocardiogram
5. CT scan thorax
6. Ultrasound
7. Endoscopy etc.
TREATMENT:
The most definitive treatment of chest pain is to find the cause and cure it. In some cases reassurance that no serious disease is present, may relieve the distress. Chronic or recurrent pain may need referral to special pain clinics. Some cases may need hospitalisation. Consult your doctors at the earliest.
* Dr MA Razaque wrote this article for The Sangai Express
This article was posted on July 27, 2016.
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