Chest pain: Difference between revisions
imported>Howard C. Berkowitz No edit summary |
imported>Howard C. Berkowitz |
||
| Line 4: | Line 4: | ||
===Workup of emergent chest pain=== | ===Workup of emergent chest pain=== | ||
{{seealso|Acute cardiac syndrome}} | {{seealso|Acute cardiac syndrome}} | ||
Since many causes of acute chest pain can be immediately life-threatening, general supportive measures are begun when a more specific workup continues. Algorithms are adapted from <ref> {{citation | |||
<ref>{{citation | |||
| contribution = Chapter 12, Chest Pain | |||
| author = Chansky ME, Nyce A, Friedman J | |||
| title = Current Emergency Diagnosis and Treatment | |||
| editor = Barbarella SR, Dennis WR Jr. | |||
| edition = Fifth Edition | |||
| publisher = Lange Medical Books, McGraw-Hill | |||
| year = 2004 | |||
}}, Figure 12-1, p. 241</ref> | |||
===First categorization=== | |||
*If there is a history of chest [[trauma]], go to [[chest trauma]]. Note that chest trauma can still have major physiologic effects on the heart and lungs | |||
*If the patient is hypotensive orin shock begin [[emergency hypotension protocol]], unless the patient is also in acute distress from pain or dyspnea; if so, begin [[immediate acute cardiac syndrome care]] | |||
**Consider: | |||
***[[Aortic dissection]] | |||
***Leaking [[aortic aneurysm]] | |||
***[[Myocardial infarction]] with [[vagotonia]] | |||
**If the patient also exhibits central venous hypervolemia (e.g., jugular venous distention), consider: | |||
***[[Tension pneumothorax]] | |||
***[[Cardiac tamponade]] | |||
***[[Cardiogenic shock]] | |||
***[[Pulmonary embolism]] | |||
**If central venous hypervolemia is not present, consider: | |||
***[[Heart failure]] | |||
***[[Pericardial effusion]] | |||
==Treatment== | ==Treatment== | ||
Strong analgesics such as [[morphine]] are usually indicated in sudden, severe chest pain, with care to avoid depressing respiration. If the etiology is cardiac, morphine may improve survival as well as relieve pain. | Strong analgesics such as [[morphine]] are usually indicated in sudden, severe chest pain, with care to avoid depressing respiration. If the etiology is cardiac, morphine may improve survival as well as relieve pain. | ||
Revision as of 19:50, 22 September 2010
In medicine, chest pain is "pressure, burning, or numbness in the chest."[1] Chest pain can be caused by an extremely wide range of conditions, including some, such as myocardial infarction, which, if untreated, could lead to death within minutes or hours. Other causes may be less urgent, while others can indicate self-limiting disease. There are idiopathic chest pain syndromes that have no apparent cause.
Diagnosis
Workup of emergent chest pain
- See also: Acute cardiac syndrome
Since many causes of acute chest pain can be immediately life-threatening, general supportive measures are begun when a more specific workup continues. Algorithms are adapted from Cite error: Closing </ref> missing for <ref> tag
First categorization
- If there is a history of chest trauma, go to chest trauma. Note that chest trauma can still have major physiologic effects on the heart and lungs
- If the patient is hypotensive orin shock begin emergency hypotension protocol, unless the patient is also in acute distress from pain or dyspnea; if so, begin immediate acute cardiac syndrome care
- Consider:
- Aortic dissection
- Leaking aortic aneurysm
- Myocardial infarction with vagotonia
- If the patient also exhibits central venous hypervolemia (e.g., jugular venous distention), consider:
- If central venous hypervolemia is not present, consider:
- Consider:
Treatment
Strong analgesics such as morphine are usually indicated in sudden, severe chest pain, with care to avoid depressing respiration. If the etiology is cardiac, morphine may improve survival as well as relieve pain.
Since chest pain is a symptom rather than a disease, diagnosis and treatment need to focus on the underlying disease(s).
Idiopathic chest pain
Among patients who have chest pain without any identifiable cause, antidepressants, either tricyclic antidepressants[2] or second-generation antidepressants[3] may reduce pain.
References
- ↑ Anonymous (2024), Chest pain (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Cannon RO, Quyyumi AA, Mincemoyer R, Stine AM, Gracely RH, Smith WB et al. (1994). "Imipramine in patients with chest pain despite normal coronary angiograms.". N Engl J Med 330 (20): 1411-7. PMID 8159194.
- ↑ Lee H, Kim JH, Min BH, Lee JH, Son HJ, Kim JJ et al. (2010). "Efficacy of venlafaxine for symptomatic relief in young adult patients with functional chest pain: a randomized, double-blind, placebo-controlled, crossover trial.". Am J Gastroenterol 105 (7): 1504-12. DOI:10.1038/ajg.2010.82. PMID 20332772. Research Blogging.