chest pain
Introduction
Introduction Chest pain is a common symptom in the emergency department. It is usually caused by chest disease. The severity of chest pain does not necessarily have a definite relationship with the cause of chest pain. For example, chest herpes zoster can cause severe chest pain, and chest pain in acute myocardial infarction is sometimes not very high. serious.
Cause
Cause
1. Inflammation: dermatitis, non-suppurative costal cartilage, herpes zoster, myositis, epidemic myalgia, pleurisy, pericarditis, mediastinal inflammation, esophagitis, etc.
2. Visceral ischemia: angina pectoris, acute myocardial infarction, cardiomyopathy, pulmonary infarction, etc.
3. Tumor: Compression or infiltration of primary lung cancer, mediastinal tumor, myeloma, leukemia, etc.
4. Other causes: spontaneous pneumothorax, thoracic aortic aneurysm, dissecting aneurysm, hyperventilation syndrome, trauma, etc.
5. Cardiac neurosis.
Examine
an examination
Related inspection
Chest flat chest perspective electrocardiogram
(1) The nature and characteristics of chest pain
1, the characteristics of chest pain: chest pain caused by chest wall disease, clear positioning, local redness, tenderness, rash, deformity.
2, the nature of chest pain: intercostal neuritis caused chest pain is paroxysmal, acupuncture-like pain. Esophagitis causes burning pain. Tear pain is more common in dissection aneurysms.
3, the site of chest pain: Post-sternal pain is common in angina. Left front chest pain can also be angina pectoris, myocardial infarction, left pneumonia. Chest pain is radiated to the left shoulder and is mostly angina.
(ii) Common diseases that cause chest pain
1, pleural disease: such as pleurisy, spontaneous pneumothorax, chest pain caused by these diseases and breathing, cough. Chest pain is aggravated during deep breathing and coughing, often accompanied by difficulty breathing. Chest pain is located on one side of the lesion.
2, cardiovascular disease: angina pectoris, myocardial infarction as the representative, followed by pericarditis. This type of chest pain is often manifested in the precordial area and post-sternal compression, squeaky pain, and even tearing pain. Often radiated to the left shoulder, neck and the inside of the left arm, with severe symptoms of shock.
3, intercostal neuritis, herpes zoster, esophagitis: can cause chest pain, severe chest pain when herpes zoster, along the intercostal space, 1 to 2 days after the skin appeared dense blisters.
4, some abdominal organ lesions cause chest pain: such as underarm abscess, acute cholecystitis, acute pancreatitis.
5 chest trauma is common in rib fractures, a history of chest trauma, increased chest pain when breathing or coughing.
(3) Emergency measures for severe chest pain
(1) Suspected angina pectoris, immediate oxygen, rest, nitroglycerin under the tongue.
(2) Chest pain caused by pleurisy or chest wall disease, the chest wall can be fixed in the pain with a wide abdominal belt to reduce the movement of the thorax during breathing.
(3) Go to the hospital immediately to make an electrocardiogram and X-ray examination. For the treatment of the cause.
(4) Take appropriate painkillers.
Diagnosis
Differential diagnosis
Chest lightning pain: If chest pain occurs for a short time and is like a lightning tingling, most are not angina, it is likely intercostal neuralgia. There was a sting in the chest, although not intense, it felt like a bolt of lightning across the chest. In the intercostal neuralgia of the intercostal neuralgia, it can be seen that the pain is delayed from the posterior to the posterior and along the corresponding intercostal space; the pain is stinging or burning pain. Pain worsens when coughing, taking a deep breath, or sneezing. The pain is more common in one nerve on one side. Frequent pain in one or several intercostal spaces occurs mostly in the 5-9 intercostal space on the right side. It is sometimes exacerbated, sometimes stimulated by breathing action, and the pain is aggravated by coughing and sneezing. During the examination, the hypersensitivity of the corresponding skin area and the tenderness of the corresponding rib edge can be found. Especially after the intercostal nerve penetrates the intervertebral foramen, the back, chest side wall and front chest piercing are particularly prominent. The angina pectoris is in the left apex, the time is longer, there is a sense of sudden death during the attack, and nitroglycerin can be relieved. It is easy to identify through symptoms.
Smoking chest pain: spontaneous pneumothorax, patients will have chest pain, chest tightness, shortness of breath, and the majority of chest pain. Due to the young, tall and thin reasons, patients often do not care, ignoring the importance of medical examination.
Atypical chest pain, the symptoms of chest pain are not typical, clinical chest pain, chest discomfort is a common symptom, and its clinical manifestations vary. Such as stomach pain, neck pain, toothache, sore throat and so on. This pain has a common feature - it happens when you exercise, and it takes a few minutes to rest soon. Caused by major cardiovascular diseases.
Angina pectoris: a clinical syndrome characterized by episodes of chest pain or chest discomfort caused by acute coronary insufficiency, acute myocardial ischemia, and hypoxia. It is characterized by paroxysmal chest compression pain, which can be accompanied by other symptoms. The pain is mainly located in the posterior part of the sternum and can be radiated to the anterior and left upper limbs. It often occurs during labor or emotional excitement. ~5min, can be used once a day, or several times a day, rest or disappear after using nitrate ester preparation. The disease is more common in men, most patients are over 40 years old, tired, emotional, full of food, cold, rainy weather, acute circulatory failure are common causes.
