سلسلة التعليم اون لاين >>> Chest Pain

ن شاء الله - هنتكلم عن الـ

Chest Pain

وطبعا كلنا لما اشتغلناعرفنا اد ايه الموضوع ده مهم .. بس هنحاول مع بعض نخليه
Clinical


اكتر منه نظري علشان نستفيد منه ...


Chest pain is one of the most frightening symptoms a person can have.

It is sometimes difficult even for a doctor or other medical professional to tell what is

causing chest pain and whether it is life-threatening.


Chest Pain Causes :-
.............................

أكيد ممكن تتخض لما تلاقي موقع كاتب

This section discusses 918 medical conditions causing Chest pain

Available to view excerpts" 40 " medical textbooks about the causes and diagnosis of

Chest pain


أولا .... أهم

Non Cardiac Causes :-
................................


* Herpes Zoster * Osteoprosis * Myositis

* Acute Dry Pleurisy * 2ry Pleurisy * Sub Phrenic Lesions

* Pneumothorax * Tension Pneumothorax * Esophageal Spasm

* Heartburn * Achalasia * Injured ribs or pinched nerves


ثانيا .... أهم

Cardiac Causes :-
..........................


* Cardiac Neurosis * Pericarditis

* Angina Pectoris * Myocardial Infarction

* Dissection of Aorta * Pulmonary Embolism





نتكلم عن كل سبب ... أهم طرق التشخيص والعلاج



Non Cardiac Causes :_
.............................

1- Herpes Zoster >> 7days of pain befor Vesicles , Mainly Posterior and strictly UNILATERAL


والعيانبيقولك " مش طايق هدومي " . .

ttt. AntiViral " Acyclovir " 800 mg orally five times daily for 7 to 10 days& analgesic ,

Prednisone may be added 30 then 15 then 7.5 mg


2 - Osteoprosis >> Strain of cough , pain increases with breathing & movement ,

mainly post menopausal women , may be followed by fracture .

.. ttt Cause " Ptn

and menirals ,, Hormonal therapy

?!!


3- Myositis >> many cases are wrong diagnosed as myositis but It's less common there

is pain when twist side to side or when raise arms

,, many cases are Costochondritis in

origin ... ttt anti inflammatory


4- Acute Pleurisy >> Pain is increased by breathing and cough " Patient holds his

breathing " Pleural rub can be auscultated

... ttt anti inflammatory and may anti Prostaglandins


5- 2ry Pleurisy >> caused by Underlying lung lesion , increased duration of 1ry pleurisy

which Didn't respond to NSAIDs or Anti PGs

Pleurisy Diagnosis MUST BE FOLLOWED UP for fear of 2ry pleurisy

لازم تتابع العيان ده .. ممكن يكون Bronchogenic carcinoma ومعاه

شوية pleurisy .. لازم تاخد بالك





6- Pneumothorax >> Benign spontaneus or 2ry .. X ray is diagnostic and proper history of cause

خصوصا لو العيان

smoker او عنده emphysema أو COPD مع شوية Cough ممكن يعمل

Rupture emph. bullae


7- Tension pneumothorax >> Cyanosis , Dyspnea , Tracheal shift

, obstructive shock - Pul. embolism or Rt Side H F - URGEGT ttt is amust


8- Sub Phrenic Sub Diaphragmatic lesions as Abcess or even Gallbladder or pancreas problems

9- Esophageal Spasm - Hiatus Hernia , Achalasia , Heartburn & GORD -

معظم الحاجات اللي فيها spasm

ممكن ندي

Ca Ch. Blockers أو حاجات Antispasm " relaxants " ومع الـ

GORD و الـ Heart burn

بندي حاجات تزود

Motility

وحاجات تقلل

Acidity



Cardiac Causes :-
............................


1- Cardiac Neurosis

May be Mitral Valve Prolapse or Psychic patient who has a relative cardiac patient >>

mainly at Left inframammary area >>

Pricking in nature >> Takes Seconds or minutes >>

Evpked by Emotions >> No specific Radiation - may to lt shoulder - >>


Positive FINGER sign , negative hand sign >>

ECG may be needed


غالبا بيكون العيان ده يعرف عيان IHD وسمع أو شاف الشكوى دي فبيكررها بس

لازم تحترم الشكوى



2 - Angina Pectoris



Increased Myocardial Oxygen demand or Decreased - Quantitive or Qualititive - Supply >>

at any site of the chest MOSTLY Retrosternal least left inframammary >>

Any type of pain mostly Comperission , least Pricking >>

Takes minutes 3-30 m. >>

Evoked by Stress, Smoking, Cold weather , Heavy meals , Wine, Women, Excercise >>

Relief by STOP ptt factor& Nitrates >>

Radiates to Lt. shoulder, inner aspect of Lt. arm , Neck& jaw >>>

Examination showes Transient tachycardia, Htn , Pericordial pulge , splitting S2

Stress ECG may be needed to diagnose silent cases

but it's not indicated in Recent pain , Changed pain ch ch ,

So Pharmachological stress test may be needed

X syndrome " +ve stress test & normal coronary Angio " in Coronary small vesseles

disease & D.M

Ttt >> Conservative Medical , Exercise " walking " , Diet


Stent as intervention


Surgery " Revascularization "


Keep LDL < 100 & HDL > 40 & Increase fish oil " Omega 3 . 6

Medical ttt of STABLE Angina

* B- Blockers decreases HR & Heart work as CONCOR 5 mg

* Ca Ch Blockers relifes spasm as Altiazem

* Anti platlets as Aspirin 300 mg after Lunch

Diseased Arteries CAN'T BE DILATED , Drugs Dilates Normal arteries only

* , Dinitra decreases Heart Work but it causes Systemic VD, Used during the Attack >>

nitroglycerin can be used in between

* Mononitrate comes next as it's more strong

3- Acute Myocardial Infarction


happens when the arteries leading to the heart become blocked and the blood supply is

slowed or stopped , Common signs and symptoms include:

Pressure,

fullness or a squeezing pain ,

Increasing episodes of chest pain ,

Prolonged pain in the upper abdomen " Epig. Pain in Inferior MI " , Shortness of
breath ,
Sweating , Impending sense of doom ,

Fainting , Nausea and vomiting


TTT

Call for emergency medical help ,

Aspirin 300 mg ,

Thrombolytics Within 30 Minutes to few hours Of Arrival for ST-elevation Myocardial Infarction ,

Superaspirins such as clopidogrel (Plavix) ,

Pain relievers such as morphine ,

Nitroglycerin or Nitrates improving blood flow to the heart Beta blockers & Cholesterol-lowering medications



طبعا في الاستقبال .. سيادتك بتديه

Aspirin 300 mg & Nitrate " Dinitra " Sublingual &

DO ECG & Call the CCU doctor


4- Pericarditis


the most common symptom is sharp,

stabbing chest pain ,

It often intensifies when Patient lie down or inhale deeply.

Coughing, taking a deep breath or swallowing food also may make the pain worse.

Sitting up and leaning forward can often ease the pain >>

Low-grade fever , An overall sense of weakness, fatigue or feeling sick ,

Dry cough


TTT


Rest , NSAIDs , Colchicine. This drug, which reduces inflammation in the body espicially

with FMF >>

Pericardiocentesis & Pericardiectomy may be indicated in complicated cases


5- Dissection of Aorta

Sudden severe chest or upper back pain,

often described as a tearing, ripping or shearing sensation,

that radiates down the back , Loss of consciousness (fainting) , Shortness of breath ,

Weakness , Stroke

Widening of the aorta on chest x-ray & CT scan , MRA , Transesophageal

echocardiography may be needed for diagnosis

An aortic dissection is a medical emergency requiring immediate treatment ,

Surgery is the preferred treatment ...

Medications,

such as beta blockers and sodium nitroprusside,

to relieve the force of blood on the aortic wall by reducing the heart rate and lowering
blood pressure.



واضح ان العيان لازم يكون عامل حسابه .. يحصله

Dissection of Aorta

في المستشفى .. ولازم يكون مستشفى محترم كمان وإلا مش هيكمل


6- Pulmonary embolism

Sudden shortness of breath , Chest pain that often mimics a heart attack , A cough

that produces bloody or blood-streaked sputum , tachycardia

Lung scan ventilation-perfusion scan (V/Q scan) >> lung scans

are being replaced by more sensitive and rapid tests, such as spiral computerized

tomography (CT) scans.

Pulmonary angiogram & D-dimer blood test

Venography & Blood tests

TTT

A pair of anticoagulants ..

fast-acting anticoagulant heparin ,

intravenously or subcutaneously ..

then the anticoagulant warfarin

Clot-dissolving (thrombolytic) therapy & Vein filter






أهم

حاجة أنك تاخد

history

بسرعة أول ما تشوف العيان ... وتتأكد من

" Diabetes , Htn & IHD "

لان ده يمشيك في طريق Cardiac causes

***

عيان ال

Diabetes

ممكن يجي ب


Atypical chest pain

علشان كده بنحترم chest pain في اي عيان Diabetic ولازم تعمل له ECG


أهم investigation

بنعملها للعيان هي ECG

علشان تستبعد ال

MI


MI و IHD ولو شاكك في

ممكن تطلب

Cardiac Enzymes



>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>




Based on


Dr. Hosam Moafi Lectures >> Egy. Med. Syndicate 2009

Harrison's 17th internal medicine

Mayo Clinic and other Websites

*********************************************

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Good luck

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