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Chest Pain

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Description of chest pain
A thorough description of the pain is an essential first step in the diagnosis of chest pain

Quality of the pain
The patient with myocardial ischemia often vigorously denies feeling chest "pain." More typical descriptions include squeezing, tightness, pressure, constriction, strangling, burning, heart burn, fullness in the chest, a band-like sensation, knot in the center of the chest, lump in the throat, ache, heavy weight on chest (elephant sitting on chest), like a bra too tight, and toothache (when there is radiation to the lower jaw). In some cases, the patient cannot qualify the nature of the discomfort, but places his or her fist in the center of the chest (the "Levine sign").
A "sharp" or "stabbing" pain with a pleuritic or positional component that is fully reproducible by palpation, in patients who have no history of angina or myocardial infarction, probably have low-risk for the episode being ischemic.

Region or location of pain
Ischemic pain is a diffuse discomfort that may be difficult to localize. Pain that localizes to a small area on the chest is more likely of chest wall or pleural origin rather than visceral. Referred pain is an exception.
Radiation

The pain of myocardial ischemia may radiate to the neck, throat, lower jaw, teeth, upper extremity, or shoulder. A wide extension of chest pain radiation increases the probability that it is due to myocardial infarction. Radiation to the right arm may be a particularly useful finding. In one study 48 of 51 patients who presented to an emergency department with chest pain that radiated to the right arm suffered from coronary disease; 41 had a myocardial infarction. Radiation to both arms is an even stronger predictor of acute myocardial infarction. Acute cholecystitis can present with right shoulder pain, although concomitant right upper quadrant or epigastric pain is more typical than chest discomfort. Chest pain that radiates between the scapulae may be due to aortic dissection.

Temporal elements
The time course of the onset of chest pain may be a very useful distinguishing feature:
  • The pain associated with a pneumothorax or a vascular event such as aortic dissection or acute pulmonary embolism typically has an abrupt onset with the greatest intensity of pain at the beginning.

  • The onset of ischemic pain is most often gradual with an increasing intensity over time. A crescendo pattern of pain can also be caused by esophageal disease.

  • "Functional" or nontraumatic musculo-skeletal chest pain might have a much more vague onset.

  • The duration of pain is also helpful. Chest discomfort that lasts only for seconds or pain that is constant over weeks is not due to ischemia. A span of years without progression makes it more likely that the origin of pain is functional.

  • The pain from myocardial ischemia generally lasts for a few minutes; it may be more prolonged in the setting of a myocardial infarction.

  • Myocardial ischemia may demonstrate a circadian pattern. It is more likely to occur in the morning than in the afternoon, correlating with an increase in sympathetic tone.

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ossiva06
my father is suffering from chest pain . which doctor i want to consult in chennai
ossiva06  Thursday, July 12, 2012
Edphil
I have a right side chest pain that radiates to the arm.I have been feeling this pain in a dull manner for more than six months now but the radiation to the arm started recently.I have been for a chest x-ray and waiting for the result.The pain goes off temporarily if I indulge in exercise for more than 30 minutes but comes back in the morning.Today it was persistent that I can hardly raise my right arm or carry my baby.I am waiting for the test result before I get back to the GP.Please tell me what to do.
Edphil  Thursday, June 07, 2012
shaanZee
my husband age 33 has a pain in chest from few days if he walk fast
shaanZee  Wednesday, October 27, 2010
MandarS
Recently I Lost my mother by heart attached on 21.09.2010, she got chest pain at 10.30pm I call doctor near to me (BAMS) she miss guide me that chest pain due to acidity becouse my mother BP and heart beat is normal at that time and chest pain is in centre part of chest as inform by that doctor.

Still for safer side we moved her to cardiologst he take ECG & infor its start of heart attack, he gave her sorbitol & some liquid syrup & asked to move to ICCU.
I call abilance from Wackharts but during trasit she got attack and she pass away.

The mistake we have done,
Loss the time to investigate reason of chest pain
Suggession :-
Do not wait to invetigate rason for chest pain, just move to the hospital who can investigate & treat the chest pain reason whatever maybe.
MandarS  Monday, October 18, 2010
nancyk
I have chest pain on the right side and in right arm. Chest Pain started early morning before sun came up. Right arm started around lunch time. Should I go to emergency room?
nancyk  Saturday, September 25, 2010
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