Chest Pain Diagnosis

Chest Pain

• Chest pain may not be serious, but it's essential to consider life-threatening conditions like myocardial infarction (M.I), pulmonary embolism (P.E), dissecting aortic aneurysm, or pericarditis.

Causes of Chest Pain

• Anxiety or emotional
• Cardiac causes:
  • Myocardial ischemia (angina)
  • Myocardial infarction (M.I)
  • Aortic stenosis
  • Aortic aneurysm/aortic dissection
  • Pericarditis/Myocarditis
  • Mitral valve prolapse
• Lung and pleura causes:
  • Bronchospasm
  • Tracheitis
  • Pneumonia
  • Pulmonary infarction/pulmonary embolism (P.E)
  • Pneumothorax
  • TB
  • Malignancy
  • Connective tissue diseases
• GIT causes:
  • Oesophagitis
  • Oesophageal spasm
  • Mallory-Weiss syndrome
• Musculoskeletal disorders:
  • Arthritis
  • Costochondritis
  • Intercostal muscle injury
  • Rib fracture or injury
  • Epidemic myalgia (Bornholm disease) caused by Coxsackie viral infection
• Neurological disorders:
  • Prolapsed intervertebral disc
  • Herpes zoster
  • Thoracic outlet syndrome

Analyzing Chest Pain with SOCRATES Questions

• Site:
  • Cardiac pain is typically located in the center of the chest
• Onset:
  • M.I develops gradually (takes several minutes or even longer)
  • Angina develops gradually depending on the intensity of exertion
  • P.E, pneumothorax, and aortic dissection pain are very sudden
• Character:
  • Cardiac pain is constricting, dull, choking, or heavy pain
  • Pain due to pleura or pericardium is sharp, stabbing, or knife-like pain
  • Aortic dissection results in tearing, instantaneous pain
• Radiation:
  • Ischemic cardiac pain typically radiates to the jaw, neck, either or both upper arms
  • Aortic dissection pain is tearing, instantaneous interscapular pain
  • Epigastric pain could be cardiac in origin
• Associated symptoms:
  • Autonomic symptoms: nausea, vomiting, pallor, and sweating
  • Dyspnea: result from left ventricular ischemia, P.E, lung and pleural disorders, and anxiety
  • GIT symptoms: due to esophagitis, esophageal reflux, peptic ulcer, and biliary disease
• Timing/duration:
  • Prolonged chest pain (>30 min) suggests M.I
• Exacerbating and relieving factors:
  • Exacerbating: angina pain occurs during (not after) exercise, and cardiac pain occurs with palpitation, exposure to cold, after a heavy meal, and emotional stress

Identify the causes of chest pain, differentiating between cardiac and non-cardiac conditions, and learn how to diagnose them through history, physical examination, lab findings, and imaging techniques.