RESPIRATORY

MUSCULOSKELETAL

CARDIOVASCULAR

OTHERS

CHEST PAIN

Cardiovascular

Angina Pectoralis

Myocardial Infarction

Pericarditic Pain

Aortic Pain

Angina Pectoris Retrosternal (radiates to arm and jaw),tight or pressing band-like similar to a heavy weight Precipitated by exertion and relieved with rest or nitrates, ache or dull comfort Not accompinied with heartburn last for about 2-10 min Its may radiate on both arms its throat, jaw and teeth Its unaffected by inspiration, twisting or turning

Myocardial Infarction Site similar as angina More severe and prolonged, sweating, pallor, nausea, vomiting, diarrhea Persists with rest, accompanied with restlessness, breathlessness and feeling of impending death (angor animi)

Pericarditic Pain
Sharp, raw or stabbing pain in the mid-chest, worsened by deep breaths Varies with movement or breathing, pain is worsened by lying flat and improved by leaning forward Many people report a recent cold, fever, shortness of breath, or pain when swallowing just before developing pericarditis.

Aortic Pain
Severe Pain Tearing and sudden in onset Radiates to the back (typically interscapular) Accompinied with profound autonomic stimulation

Mitral Valve Prolapse Symptoms

people experience palpitations (sensation of rapid or strong heartbeat) and chest pain. it is sharp does not radiate and is not related to physical exertion. Other symptoms include fatigue, lightheadedness, and shortness of breath.

Pneumonia Symptoms
chest pain is pleuritic, hurting when taking a deep breath usually one-sided an is worsened by coughing associated symptoms include fever, coughing up mucus (sputum), and shortness of breath

Pneumothorax
acute onset of sharp chest pain associated with shortness of breath with no preceding illness or warning Physical examination reveals decreased air entry on the affected side

Pulmonary embolism
A blood clot to the lung, pleuritic chest pain, shortness of breath coughing up blood (hemoptysis) patient can also have anxiety and sweat profusely size of the clot, the initial presentation may be fainting (syncope) or a passing-out spell.

Pneumothorax

Gastroesophageal reflux disease (GERD)

heartburn, painful swallowing, excessive salivation, dull chest discomfort, chest pressure, or severe squeezing pain across the mid chest. You may feel uncomfortable or may experience:

profuse sweating pallor nausea vomiting sour or bitter taste in the mouth or throat hoarseness, and persistent dry cough.

Pain from GERD is often relieved with antacids

Esophagitis
Difficulty swallowing Painful swallowing The chest pain comes on suddenly and is not relieved by antacids.

Esophageal spasm
usually intermittent and dull It is located in the mid-chest radiate to the back, neck, or shoulders.

Musculoskeletal Pain
Maybe due to Fracture of ribs Metastatic deposits in the ribs Costochondritis Spinal root lesion Herpes Zoster

Broken or bruised ribs

Tenderness A broken rib may be palpated The pain tends to be pleuritic (it hurts to take a deep breath and can be associated with shortness of breath). Because the surrounding muscles go into spasm, there is pain with any movement of the trunk.

Costochondritis
This is an inflammation of the cartilage between the ribs Pain is typically located in the mid-chest with intermittently dull and sharp pain may be increased with deep breaths, movement, and deep touch

Questions the doctor may ask about chest pain

When did the pain start? What is the quality of the pain? How long does the pain last? Does the pain come and go? What makes the pain better? What makes the pain worse? Does the pain radiate somewhere (move to another area of the body)? Has there been any preceding illness? Has there been any trauma? Have there been similar episodes of pain in the past?

Questions about the associated symptoms

Is there shortness of breath? Fever or chills? Cough? Nausea or vomiting? Sweating?

Questions about risk factors for disease

Risk factors for heart disease Smoking High blood pressure High cholesterol Diabetes Family history

Risk factors for pulmonary embolus (blood clot to the lung)

Prolonged inactivity such as bed rest, long car or airplane trips Recent surgery Fractures Birth control pill use (particularly if the patient smokes cigarettes) Cancer

Risk factors for aortic dissection

High blood pressure Marfan syndrome Ehlers-Danlos syndrome Polycystic kidney disease Cocaine use Pregnancy

Physical examination helps!

Head and neck Looking for neck vein distension or bulging Listening over the carotid arteries for bruits (abnormal sounds) or murmurs Chest wall Palpate for rib or muscle tenderness Look for rashes Lungs Listen for abnormal lung sounds or decreased air entry Heart Listen for abnormal heart sounds, murmurs or rubs (a friction sound made by two rough surfaces rubbing against each other, which may be seen with inflammation of the heart lining, called pericarditis) Listen for muffled heart tones Abdomen Palpate for tenderness or masses Listen for bruits over the aorta Extremities Feel for pulses

Referred abdominal pain

Conditions in the abdomen can present as pain referred to the chest, especially if there is inflammation along the diaphragm. Inflammation of the stomach, spleen, liver, or gallbladder can initially present with non specific pain complaints that may be associated with vague chest discomfort.