CHEST PAIN
Pain in the chest is sometimes cause of Musculoskeletal conditions.An example is Tietze's disease.In this condition ,pain arises from the costochondral junctions.It is usually unilateral and affects one,two or three ribs. There is local tenderness ,which helps to make diagnosis.The condition is benign and self-limitin.It often responds well to anti-inflammatory drugs.Other causes of chst wall pain include rib fractures due to trauma or osteoporosis or a malignant deposit.
Chest pain may appear suddenly at any time. Try to ignore at first, but your chest pain has you scared and worried. Chest pain is one of the most common causes of application for emergency medical assistance. All medical emergency room doctors Every year evaluate and treat millions of people with chest pain.
There is little correlation between the severity of chest pain and the seriousness of its cause.
POSSIBLE SERIOUS CAUSES
The differential diagnosis of chest pain as (1).new ,acute ,and ongoing .(2).Recurrent,episodic and (3).persistent,sometimes for days.
MYOCARDIAL ISCHEMIA
*ANGINA PECTORIS
Substernal pressure,squeezing ,constriction ,with radiation typically to left arm; usually on exertion,especially after meals or with emotional arousal,
Characteristically relieved by rest and nitroglycerine.
*ACUTE MYOCARDIAL INFARCTION
Similar to angina but usually more severe ,of longer duration ( > or equal 30 min ) and not immediately relieved ,and hypoxemia.
PULMONARY EMBOLISM
May be substenal or lateral ,pleuritic in nature ,and associated with hemoptysis ,tachycardia , and hypoxemia.
AORTIC DISSECTION
Very severe in center of chest ,a "ripping " quality ,radiates to back ,not affected by changes in position.May be associated with weak or absent peripheral pulses.
MEDIASTINAL EMPHYSEMA
Sharp,intense,localized to substernal region ,often associated with audible crepitus.
ACUTE PERICARDITIS
Usually steady ,crushing ,substernal,often has pleuritic comonent aggravated by cough,deep inspiration, supine positio,and relieved by sittingg upright ,one,two ,or three-component pericardial friction rub often audible.
PLEURISY
Due to nflammation,less commonly tumor and pneumothorax.Usually unilateral ,knifelike ,superficial,aggravated by cough and respiration.
LESS SERIOUS CAUSES
*COSTOCHONDRAL PAIN
In anterior chest ,usually sharply localized.may be brief and darting or a persistent dull ache.Can be reproduced by pressure on costochondral and /or chondrosternal junctions.In Tietze's syndrome ( costochondritis ) ,joints are swollen ,red , and tender.
*CHEST WALL PAIN
Due to strain of muscles or ligaments from excessive exercise or rib fracture from trauma,accompanied by local tenderness.
* ESOPHAGEAL PAIN
Deep thoraci discomfort; may be accompanied by dysphagia and regurgitation.
EMOTIONAL DISORDERS
Prolonged ache or dart like,grief,flashing pain.associated with fatigue,emotional strain.
OTHER CAUSES
(1) Cervical disk.(2) Osteoarthritis of cervical or thoracic spine. (3) Abdominal disorders ,peptic ulcer, hiatus hernia ,pancreatitis ,biliary colic . (4) Tracheobronchitis,pneumonia. (5) Disese of the breast ( inflammation ,tumor ). (6) Intercostal neuritis ( herpes zoster ).
