CHEST PAIN

Pulmonary Medicine Department

Ain Shams University

http://telemed.shams.edu.eg/moodle5

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Contents:

Causes

Types & Character

Analysis

Diagnosis

Quiz

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Causes of Chest Pain

CardiacNon-Cardiac

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Causes of Chest Pain Chest Wall Diseases:

Muscular strain.

Intercostal myositis.

Thoracic Herpes Zoster.

Intercostal nerve infiltration.

Rib fracture.

Rib tumors (1ry or metastatic).

Pleural Diseases:

Pleurisy.

Pneumothorax.

Pleural effusion.

Mesothelioma.

Metastatic tumors.

Mediastinal Causes:Cardiac ischemia & MI.

Oesophagitis.

Pericarditis.

Mediastinitis.

Aortic dissection.

Thymoma.

Retrosternal goitre.

Mediastinal LDN

Airway & Lung Causes:

Tracheitis.

Pneumonia

Endotracheal intubation.

Central bronchial carcinoma.

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Cardiac & Non-Cardiac Chest Pain

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Causes of Acute Chest Pain:

Coronary artery disease

Pulmonary embolism/infarction

Pneumothorax

Pleurisy/ Pericarditis

Dissecting aortic aneurysm

Esophageal spasm

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Types & Character of Chest Pain:

Tracheal pain: retrosternal, burning, ↑ by coughing.

Pleural pain: stitching , stabbing (or) dull aching, ↑ with coughing & inspiration, ↓ by holding breath & associated with suppressed cough & dyspnea.

Cardiac pain: retrosternal compressing radiating to the left shoulder, neck & epigastruim.

Pericardial pain: retrosternal, stabbing, ↑ by deep breathing & swallowing, ↓ by sitting & leaning forward.

Aortic pain: severe, sharp stabbing, interscapular (or) anterior chest, & radiating to the interscapular area.

Reflux pain: retrosternal & epigastric, burning, ↑ after meals.

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Analysis of Chest Pain:

Onset

Course

Duration

Character: stitching, stabbing, sawing (or) burning.

Site

Radiation (or) Referral

What ↑ & what ↓

Severity: Interfering with daily activity (or) sleep rhythm.

Associated symptom

History of trauma (or) surgery

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Diagnosis of Chest Pain: History:

Onset & duration.

Associated risk factor for ischemic heart disease e.g. smoking, hyperlipidaemia, strong family history, hypertension, diabetes (if MI or angina are suspected).

History of recent immobilization (if pulmonary embolism is suspected).

History of hypertension (if aortic dissection is suspected).

History of hemoptysis (if pulmonary embolism is suspected).

History of smoking or lifting heavy objects (if pneumothorax is suspected).

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Examination:Diminished air entry & hyperresonance (if pneumothorax is suspected).

Swollen tender calf muscles (if pulmonary embolism is suspected).

Pleural friction rub (if pleurisy is suspected).

Pericardial friction rub (if pericarditis is suspected).

Early diastolic murmur of AI (if aortic dissection is suspected).

Diminished air entry & dullness (if pleural effusion is suspected).

Bronchial breathing & fixed crepitations (if pneumonia is suspected).

Diagnosis of Chest Pain:

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Investigations:Chest X ray (if pneumothorax, pleural effusion, pulmonary infarction, pneumomediatinum, pneumonia or fracture ribs are suspected).

Dopplex (if pulmonary embolism is suspected).

ABGs (if pulmonary embolism is suspected).

Complete blood picture & sputum work up (if pneumonia is suspected).

Echo cardiography & spiral CT scan for chest & abdomen (if aortic dissection is suspected).

ECG, cardiac enzymes & cardiac troponin-T (if MI or unstable angina are suspected).

Amylase level (if rupture esophagus is suspected).

Diagnosis of Chest Pain:

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24 Years old male presented to the ER with chest pain in the right hemithorax, acute onset followed by dyspnea at rest not associated with orthopnea or PND.

On examination: diminished breath sounds over the right hemithorax.

Routine lab. Investigations were normal.

ECG was done.

CXR was done.

Quiz

What is your diagnosis?

What is your management?

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56 Years old female presented to the ER with retrosternal stabbing chest pain, acute onset along with dyspnea at rest not associated with orthopnea or PND.

On examination: epigastric tenderness.

Routine lab. Investigations were normal.

ECG was done.

CXR was done.

Quiz

What is your diagnosis?

What is your management?

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75 Years old male with CVS presented to the ER with recurrent right sided stitching chest pain, acute onset, resolved spontaneously without treatment, along with dyspnea at rest not associated with orthopnea or PND.

On examination: NAD

History prolonged recumbancy.

ECG was done.

CXR was done.

Quiz

What is your diagnosis? What is your

management?

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