chest pain

fatimah alshamrani

critical diagnoses causing chest pain:

-Acute coronary syndrome (ACS).

-aortic dissection.

-pulmo-nary embolism (PE).

-pneumothorax.

- pericarditis with tamponade.

- esophageal rupture

Pathophysiology

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Afferent fibers from the heart, lungs, great vessels, and esophagus enter the same thoracic dorsal ganglia. Through these visceral fibers, each organ produces the same indistinct quality and location of pain. The quality of visceral chest pain varies widely and is described as “burning,” “aching,” “stabbing,” or “pressure.

Because dorsal segments overlap three segments above and below a level, disease of a thoracic origin can produce pain anywhere from the jaw to the epigastrium. Radiation of pain is caused by somatic afferent fibers synapsing in the same dorsal root ganglia as the thoracic viscera.

This stimulation can confuse the patient’s central nervous system into misperceiving that the pain originates in the arms, shoulders, or neck.

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History :

- the character:

- patient’s activity at the onset of pain :

-The location:

-radiation of pain :

-Duration of pain :

-aggravating or alleviating factors

- associated symptoms

- history of prior pain and diagnosis of that episode

- A prior history of cardiac testing, such as stress testing, echocardiography, or angiography, may be useful in determining if the current episode is suggestive of cardiac disease.

-The presence of risk factors for a particular disease .

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Physical Examination

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- cardiac enzyems.

-ct .

- D dimer .

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-All patients, except those with obvious benign causes of chest pain, undergo electrocardiography as soon as possible.

-In clinical evaluation of the patient, the initial questions are “Should I intervene now?” and “What are the life-threatening possibilities in this patient? after assessment of the patient’s appearance, ECG, vital signs