by the notes of dr. Claudio Italiano
The first thing to do, in the case of chest pain, is:
do not neglect the symptom of chest pain!
Never think that a pain in the chest is caused by cold and pleurisy or acidity
or oesophagitis. But it is necessary to go immediately to the doctor, better if
in the emergency room, especially if we have accused the fatigue and the lack of
air, a sense of oppression in the chest, like a pincer that tightens!
Furthermore, chest pain with hypoxemia may mean a dissecting aortic aneurysm or
pulmonary embolism. Therefore, if the ECG is negative for the STEMI or NSTEMI
acute coronary syndrome, it is always advisable to perform a chest CT scan to
exclude pulmonary embolism, pneumothorax or aneurysm of the aorta.
Chest pain depends on the different structures of the thorax, ie the parietal,
cutaneous, muscular, articular structures and the organs contained in it.
Sometimes it can be a pain in the chest that is not responsive to therapy.
The most common explanation of recurrent retrosternal chest pain with negative cardiac evaluation is represented by GERD (Fang kman, 2001), ie gastroesophageal reflux disease. Approximately 15% of patients have endometria esophagitis and up to 40% of patients have high acid exposure times during 24-hour pH monitoring. The remaining subgroup of patients does not present pathological reflux. About one-third of these show an association of symptoms with episodes of acid reflux, but, taken together, all patients without pathological reflux respond less well to antireflux therapy.
Chest, X-ray: the tumor lesion can be detected as
a double thickening area under the port-a-cath,
with a round shape
Depend on:
- from muscles, tendons and fascias such as myofascial or myogenic pain:
myositis, fibrositis, tendonitis;
- from joints and periarticular tissues such as arthrogenous pain: acute and
chronic arthritis, periarthritis, bursitis.
- pains from osteo-neuro-muscular lesions.
- pain in the left shoulder (see also Carcinoma of lung).
Muscular chest pain is a profound, mal-localized pain that accompanies the sense of tension and recognizes "trigger points" or painful outbreaks, which can result from trauma, myositis, prolonged muscle fatigue, arthritis and exacerbate with cold and heat. , with movements, muscle fatigue, is accompanied by contractures. Muscular pain occurs in fibrositis, ie pain in the fascia, muscles and ligaments. (see dermatomyositis and dermatomyositis, dermatomyositis, dermatomyositis and polymyositis, dermatomyositis and polymyositis, diagnosis and treatment). The common facilities may be home to algogenic foci; for example. the intervertebral and vertebro-costal joints in the course of septic arthritis by neisseria gonorrhea, staphylococcus aureus, streptococcus pyogenes, etc; a pain of these joints also extends to the affected muscles; the same applies to rachis disorders, traumatic, osteoarthritic, inflammatory, disc herniation (see back pain) A throbbing pain in the back: spondylodiscitis, neoplasia, osteoporosis, connective tissue and rheumatic diseases in general (see also autoimmune m .), -> pressure on the ligaments evokes pain for the fibrositic process. An intercostal pain may occur due to the presence of algogenic foci of the intercostal muscles during an inflammatory process, which is accentuated with the movements of the breath; species in the points of Valleis and may depend on bone metastases in the course of the plasmacytoma, primary and secondary bone tumors, intercostal fractures or subluxations or due to the involvement of the herpes zoster of the intercostal nerve roots; the polimialgica syndrome manifests itself with the involvement of the proximal muscle masses of the muscles of the neck, shoulder and back, as chronic pain syndrome, bilateral, nocturnal, deep fatigue, pain exacerbated by the movement during the Polymyalgia Rheumatica, with muscle damage, increase in CPK, SGOT, LDH, autoantibodies (see patient's approach).
- Pleural pain: the visceral flap has a poor algogenic reactivity, unlike the parietal leaf which has a sensitivity very close to that of the skin, the pain is intense, exacerbated by the breath, if the diaphragmatic pleura is felt in the felling areas, if in the peripheral area innervated by the intercostal nerves it is located in the anterior area at the base of the thorax or in the middle of the abdomen; if the mediastinal pleura is involved, it is felt in the parasternal region and the patient has in any case a forced decubitus on the side of the deposit, if this is unilateral; percussion we appreciate the triangle Garland and Grocco separated by a dull line, there will be hypomobility of the lung bases, the FVT is reduced, the MVF is abolished. (See patient with pleural effusion Pleural fluid evacuation Treatment of pleural effusion: pleurodesis chest radiographs Examples of standard radiographs of thoracic thoracic and plaques Examples of standard chest radiographs: tumors and massive effusions).
- Pulmonary pain: the lung is painful in pulmonary embolism, with variable pain
between the small embolism and the massive one; in the most striking case it is
a deep, constrictive, badly located or retrosternal pain associated with
dyspnoea and shock, with negative analysis of enzymes and hemogas (see acid-base
balance) with <paO2 at 50 and paCO2 <30 mmHg. In the other event, it can
simulate a crisis of angina. Pneumonia: pain due to inflammation of the pleura,
a hemorrhage, exacerbated by breathing, burning, evoked by palpation,
hypophonesi, decreased MVF. In lung cancer (Lung carcinoma
Classification of diagnostic lung tumors and staging of lung cancer) is a poorly
tolerable thoracic-brachial pain due to the involvement of the pleura and the
costal periosteum, of nerve, deaf and gravitational branches, in the
acromiodeltoid region and scapular. The cutaneous and muscular pain is true
parietal, for trophic disorders of muscles and neurodystrophies.
- Bronchi and trachea: poorly algogenic, only for inflammation and distension;
the pain in the trachea is felt in the left neck and bronchi in the left breast
region and right in the right hypochondriac region. In the case of bronchogenic
tumors (Lung carcinoma Classification of diagnostic lung tumors and
staging of lung cancer) the pain is opaque, severe for the shoulder and for the
scapula and the inframammary or lateral if it also affects the pleura.
-
Pericardial pain. Punctuating, penetrating, high retrofit burning, exacerbated
by breathing and movements; it can be irradiated in the neck, at the shoulders,
in the region above and below the skin, at the nape of the jaw (see pericarditis
and pleural effusion).
- Cardiac pain: ischemic, profound, superficial and radiated superficial heart
disease. It depends on the release of algogenic substances, lactic acid, release
of K + following an ischemic insult. (See various topics on ischemic heart
disease and cardiac pain, ischemic heart disease: general information ischemic
heart disease: ischemic heart disease clinic: diagnosis of ischemic heart
disease: treatment for infarction treatment of chest pain: unstable angina)
- It is the pain of angina pectoris and heart attack. In the first case it lasts
10-15 minutes, it is present in the precordial site, as a clamp, urgent,
penetrating, sensitive to nitroglycerin, of a deep somatic type, radiant to the
left shoulder, to the ulnar side of the upper limb. In myocardial infarction is
a deep pain in the restroide or epigastric, which contracts, burns, like a
stabbing, which is accompanied by psychosomatic agitation and neurovegetative
signs, such as vomiting, sweating, hypotension and shock, difficult hours and
does not respond to nitroglycerin; it is accompanied by hypokinetic and
hyperkinetic arrhythmias, elevated enzymes. It is expressed as true superficial
pain and occurs in the left parasternal paravertebral position and left at D2,
D4; as superficial irradiated, on the arm, on the forearm, on the neck of the
hand, on the face of the jaw.
- Aortic aneurysm pain: it is reported on the right side of the collose the
ascending tract is affected either on the left side and on the shoulder; it is
accompanied by dysphonia, dysphagia and is felt like a tear and accompanies the
shock, the agitation, the sweating and spreads to the back, the sacrum, the
abdomen and the groin. It is not sensitive to nitroglycerin and responds very
little to opiate pain. To the undersigned, during a shift, of First Aid, a
patient arrived with 4 g / dl of hemoglobin and 1000 platelets, with pulsating
mass at the epigastrium
- Pain of the esophagus, retrosternal, with greater intensity to the
xipho-epigastric, burning, retrosternal region that radiates to the pharynx in
reflux esophagitis, responds to therapy with antacids;