ER Chest Pain

8/14/2019 ER Chest Pain

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CHEST PAINCHEST PAIN

BYBY

DR. OMAIMA FATHYDR. OMAIMA FATHY

E.R. SPECIALISTE.R. SPECIALIST


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Chest painChest pain

Common complaint of acute care settings.Common complaint of acute care settings.

5% of ED visits.5% of ED visits.

3-10% discharged inappropriately.3-10% discharged inappropriately.

Differentiating between ischemic and non-Differentiating between ischemic and non-

ischemic causes can be difficult.ischemic causes can be difficult.


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Severity of Chest pain correlatesSeverity of Chest pain correlates

with gravity of its causewith gravity of its cause

WRONGWRONG


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PathophysiologyPathophysiology

Alternate pain fibers are classified into 2 broad categoriesAlternate pain fibers are classified into 2 broad categories Visceral &Visceral &Somatic.Somatic.

Pain from visceral fibers is more difficult to describe & is preciselyPain from visceral fibers is more difficult to describe & is preciselylocalized.localized.

Those experiencing visceral pain are more likely to use terms such asThose experiencing visceral pain are more likely to use terms such asdiscomfortdiscomfort,, heaviness,heaviness, or aching.or aching.

Visceral pain fibers are found in internal organs such as blood vessels.Visceral pain fibers are found in internal organs such as blood vessels.

Further, patients frequently misinterpret the origin of visceral pain becauseFurther, patients frequently misinterpret the origin of visceral pain becauseit is the esophagus, and the visceral pleura.it is the esophagus, and the visceral pleura.

The dermis and parietal pleura are innervated by somatic pain fibers.The dermis and parietal pleura are innervated by somatic pain fibers.

pain from somatic fibers is usually easily described, precisely located, oftenpain from somatic fibers is usually easily described, precisely located, oftenreferred to a different area of the body corresponding to an adjacentreferred to a different area of the body corresponding to an adjacentsomatic nerve experienced as a sharp sensation.somatic nerve experienced as a sharp sensation.


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Causes of chest painCauses of chest painCardiacCardiac

VascularVascular

PulmonaryPulmonary

GastrointestinalGastrointestinal

MusculoskeletalMusculoskeletal

OthersOthers


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Cardiac causesCardiac causes

Coronary artery diseaseCoronary artery disease

Aortic stenosisAortic stenosis

HypertrophicHypertrophic

cardiomyopathycardiomyopathy

PericarditisPericarditis


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Vascular causesVascular causes

Aortic dissectionAortic dissection

Pulmonary embolismPulmonary embolism

Pulmonary hypertensionPulmonary hypertension

Right ventricular strainRight ventricular strain


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Pulmonary causesPulmonary causes

Pleuritis or pneumoniaPleuritis or pneumonia

TracheobronchitisTracheobronchitis

PneumothoraxPneumothorax

TumorTumor

Mediastinitis or mediasinal emphysemaMediastinitis or mediasinal emphysema


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Gastrointestinal causesGastrointestinal causes

Eosophageal perforationEosophageal perforation

Eosophageal refluxEosophageal reflux

Eosophageal spasmEosophageal spasm

Mallory-Wiss tearMallory-Wiss tear

Peptic ulcer diseasePeptic ulcer disease

Biliary diseaseBiliary disease

PancreatitisPancreatitis


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Musculoskeletal causesMusculoskeletal causes

Cervical disk diseaseCervical disk disease

Arthritis of the shoulder or spineArthritis of the shoulder or spine

CostochondritisCostochondritis

Intercostal muscle crampsIntercostal muscle cramps

Subacromial bursitisSubacromial bursitis


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OthersOthers

Disorders of the breastDisorders of the breast

Chest wall tumorsChest wall tumors

Herpes zosterHerpes zoster

EmotionalEmotional


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CADCAD

Stable angina pectorisStable angina pectoris

Unstable angina pectorisUnstable angina pectoris

Decubitus anginaDecubitus angina

Prinzmetals (variant) anginaPrinzmetals (variant) angina

Cardiac syndrome XCardiac syndrome X

Acute myocardial infarctionAcute myocardial infarction


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Stable anginaStable angina

Chest pain is described as heaviness, tightness, pressure,Chest pain is described as heaviness, tightness, pressure,squeezing, or choking. Lasts for 1-5 minutes.squeezing, or choking. Lasts for 1-5 minutes.

Typically pain is central/retrosternal and may radiate to, leftTypically pain is central/retrosternal and may radiate to, left

shoulder, both arms, back, neck, jaw, teeth, orshoulder, both arms, back, neck, jaw, teeth, orepigastrium.epigastrium.

Episodes are typically caused by exertion or emotion and areEpisodes are typically caused by exertion or emotion and arerelieved by rest or sublingual nitrates.relieved by rest or sublingual nitrates.

Angina may be precipitated by unfamiliar tasks, a heavy mealAngina may be precipitated by unfamiliar tasks, a heavy mealor exposure to cold.or exposure to cold.

May be accompanied by light-headedness, palpitations,May be accompanied by light-headedness, palpitations,diaphoresis , dyspnea, nausea, or vomiting.diaphoresis , dyspnea, nausea, or vomiting.


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THANK YOUTHANK YOU

ER Chest Pain

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