CHEST PAIN

CHEST PAIN


Chest pain may be a manifestation of a variety of disorders, ranging from a harmless chest cold or heartburn to a life-threatening heart attack. To try to attain a diagnosis, it is important to ask these questions:





ANGINA PECTORIS


Angina pectoris (“angina”) is caused by narrowing or obstruction (spasm or actual occlusion) of the coronary arteries, which supply the heart muscle. The pain, which lasts from 3 to 15 minutes, is most often described as heavy and pressure-like (“squeezing,” like a weight on the chest); it is classically located beneath the breastbone (but may also commonly be present in the left front chest), with occasional radiation to the jaw, back (between the shoulder blades), and left arm. Rarely, it can radiate to the right arm. Associated symptoms include nausea, sweating, shortness of breath, anxiety, and weakness. It is commonly associated with exertion, emotional stress, or both, and may be more frequent at high altitudes (this is debated by doctors), where less oxygen is available. Symptoms are sometimes worse in cold weather or after meals. “Atypical” angina is pain that occurs at rest or that awakens a victim from sleep. Women more commonly have nonclassic symptoms of angina than do men. These include irregular heartbeat, “sharp” or “stabbing” pain, pain that can be reproduced by pressing on the chest, and pain that is localized to underneath the breast. Additional symptoms in elders include shortness of breath with exercise, weakness, or sweating. A first-time angina episode, change in the pattern of existing angina episodes, or increased frequency of episodes may portend a heart attack. Angina may be relieved by rest. Persons with known angina are generally prescribed drugs: nitrates (e.g., isosorbide dinitrate), beta-adrenergic blockers (e.g., metoprolol), or calcium channel blockers (e.g., nifedipine, verapamil, or diltiazem). They also may be taking low-dose aspirin and a “statin” drug to achieve target lipid (e.g., cholesterol) levels. Any person who is taking a nitrate should not be prescribed medication for erectile dysfunction (e.g., silfenadil citrate [Viagra]).


The person who suffers from angina should be kept at absolute rest (sitting or supine) until the pain subsides. If he is carrying his medications, he should place a nitroglycerin tablet (0.4 mg) under his tongue (the tablet dissolves) or use sublingual nitroglycerin spray. If pain persists, this may be repeated after 3 to 4 minutes (not to exceed three tablets or spray applications in 10 minutes). Unless the victim is completely familiar with his angina and declares the episode typical and completely resolved, he should be transported with minimum exertion to an appropriate medical facility. If no relief is obtained, the victim may be suffering a heart attack. Expect a person with chest pain to trivialize his symptoms and deny the possibility of a heart attack.


There is a rare phenomenon, known as myocardial (heart) stunning, which is a severe, reversible abnormality is which a person without coronary artery disease suffers chest pain or decreased heart pump effectiveness (resulting in low blood pressure) when faced with a profound emotional stress, such as death of a parent or extreme fear. The precise mechanism is unknown, but the hypothesis is that this might be caused by an outpouring of “stress hormones.” This is one more reason why it is important to try to keep emotions under control in a stressful situation.

Stay updated, free articles. Join our Telegram channel

Aug 11, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on CHEST PAIN

Full access? Get Clinical Tree

Get Clinical Tree app for offline access