Chest Pain

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Provocation
The patient should be asked about factors that provoke or make the pain worse:

  • Discomfort that reliably occurs with eating is suggestive of upper gastrointestinal disease.

  • Postprandial chest pain may be due to gastrointestinal or cardiac disease; in

    the latter case it can be a marker of severe myocardial ischemia (eg, left main or three-vessel CAD.

  • Chest discomfort provoked by exertion is a classic symptom of angina,

    although esophageal pain can present similarly.

  • Other factors that may provoke ischemic pain include cold, emotional stress, meals, or sexual intercourse.

  • Pain made worse by swallowing is likely of esophageal origin.

  • Body position or movement, as well as deep breathing, may exacerbate chest pain of musculoskeletal origin.

  • Truly pleuritic chest pain is worsened by respiration and may be exacerbated when lying down.

  • Causes of pleuritic chest pain include pulmonary embolism, pneumothorax, viral or idiopathic pleurisy, pneumonia, and a pleuropericarditis

Palliation
Factors that make the pain better should be established:

  • Pain that is reliably and repeatedly palliated by antacids or food is likely of gastro-esophageal origin.

  • Pain that responds to sublingual nitroglycerin may be of either esophageal or cardiac etiology.

  • Relief of pain following the administration of a "GI cocktail" (eg, viscous lidocaine and antacid) does not reliably distinguish gastrointestinal from ischemic chest pain. On the other hand, pain that abates with cessation of activity strongly suggests an ischemic origin.

  • The pain of pericarditis typically improves with sitting up and leaning forward.

Severity
The severity of pain is not a useful predictor of CAD. As many as one-third of myocardial infarctions may go unnoticed by the patient.

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ossiva06 

my father is suffering from chest pain . which doctor i want to consult in chennai

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.

shaanZee 

my husband age 33 has a pain in chest from few days if he walk fast

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.

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?

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