Outpatient diagnosis of acute chest pain in adults
ABSTRACT Approximately 1 percent of primary care office visits are for chest pain, and 1.5 percent of these patients will have unstable angina or acute myocardial infarction. The initial goal in patients presenting with chest pain is to determine if the patient needs to be referred for further testing to rule in or out acute coronary syndrome and myocardial infarction. The physician should consider patient characteristics and risk factors to help determine initial risk. Twelve-lead electrocardiography is typically the test of choice when looking for ST segment changes, new-onset left bundle branch block, presence of Q waves, and new-onset T wave inversions. For persons in whom the suspicion for ischemia is lower, other diagnoses to consider include chest wall pain/costochondritis (localized pain reproducible by palpation), gastroesophageal reflux disease (burning retrosternal pain, acid regurgitation, and a sour or bitter taste in the mouth), and panic disorder/anxiety state. Other less common but important diagnostic considerations include pneumonia (fever, egophony, and dullness to percussion), heart failure, pulmonary embolism (consider using the Wells criteria), acute pericarditis, and acute thoracic aortic dissection (acute chest or back pain with a pulse differential in the upper extremities). Persons with a higher likelihood of acute coronary syndrome should be referred to the emergency department or hospital.
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ABSTRACT: Acute chest pain is an important medical complaint that needs proper management. The acute myocardial infarction, which is an emergency condition primarily presented with chest pain. The important concerns in management are early diagnosis and prompt treatment. An important factor determining the success of treatment is the time before visiting to the physicians. In this report, the authors summarize on the time before visiting to the physicians. It can be seen that the health education to general people on the danger of acute chest pain is required.01/2013; 2(4):330–331. DOI:10.1016/S2221-6189(13)60154-7
Article: Cardiac Syndrome X : Update 2014[Show abstract] [Hide abstract]
ABSTRACT: Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking.Cardiology Clinics 08/2014; 32(3). DOI:10.1016/j.ccl.2014.04.006 · 1.06 Impact Factor
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ABSTRACT: Although chest pain can be ascribed to a rheumatologic condition in every three cases, rheumatologists should not miss life-threatening disorders like myocardial ischaemia, pulmonar embolism, aortic dissection, aortic aneurysm, cardiac tamponade, severe pericarditis or myocarditis. In rare event, chest pain can herald the dissection of pulmonary artery. The diagnosis of pneumonia, pleuresia, mesothelioma and pneumothorax can be tricky. Drepanocytosis can also manifest as severe pain in the chest. Diaphragm has been proposed as the origin of pain in shrinking lung syndromes from lupus patients. Hernia through the anterior diaphragmatic foramen (Morgagni's herniation) can also induce retrosternal pain. Mediastinal tumors, mediastinal fat necrosis, and thymic disorders, from hemorragiae to infarctus, can be disclosed by chest pain, as well as the even more severe infections, pneumo-mediastins and mediastinal bleedings within mediastin (sometimes linked to the breakage of a parathyroid adenoma). Regurgitations, spasms, and functional disorders of esophagus can manifest as angina-like chest pain, as well as some esophageal ulcers and cancers. Spontaneous esophageal rupture following forced vomiting (Boerhave syndrome) leads to death in 20 to 40% of patients. Pancreas and biliary duct disorders can present as low chest pain, as well as some colitis, especially when associated with colonic interposition between the liver and the diaphragm, the so-called Chilaiditi syndrome.Revue du Rhumatisme Monographies 08/2014; 82(2). DOI:10.1016/j.monrhu.2014.06.007