chest_pain



	Chest Pain- A Medical Dilemma Dr. Noble Zachariah, Al Dhamer Center for Medical Specialties, Jahra

Of all the pains that a person might suffer, there is nothing more distressing than chest pain. It is not only because of the discomfort associated with the pain, but also due to the fear that it may be associated with a dangerous condition related to the heart. Sometimes the pain may be a diagnostic and management dilemma for the doctor even if it is not suggestive of a pain arising from the heart. In a recent study of 660 consecutive patients with chest pain attending a clinic, only 27% had a cardiac cause for their symptoms. Another group, which is particularly difficult to manage, is that with a combination of coronary heart disease and non-cardiac pain. Patients with non-cardiac pain have a good outcome in terms of mortality but continue to experience pain, tend to remain on cardiac medication, and continue to attend emergency departments, health center and outpatient clinic. If a wrong diagnosis of heart pain is initially made, the patient may still have some doubt on its subsequent denial. Studies have shown that about 50% of all patients with normal coronaries ( blood vessels supplying the heart muscles) and non-cardiac chest pain have oesophageal reflux or motility disorders, other main causes being lung or chest wall disorders, abdominal problems like gall bladder disease and psychiatric disorders. Psychiatric causes include panic, major depression, and health anxiety (hypochondriasis-like and other so called somatoform disorders). However, the clinical significance of oesophageal and respiratory abnormalities is not straightforward, as they often do not coincide with pain. Furthermore, the response to specific treatment is variable raising the possibility that these abnormalities are coincidental. Half of the patients with non cardiac chest pain have two or more of these conditions (oesophageal, respiratory, or psychiatric abnormalities). Often there are interactions between physiological and psychological causes. Psychological factors are important, even when there is no psychiatric disorder. Symptom interpretation by the patient is also influenced by his/her past experience and knowledge of illness, especially of heart disease. Once non-cardiac chest pain has occurred it may be perpetuated by secondary anxiety and by behavioural changes like avoidance of exercise, as well as by others� worries. Overcautious medical care, lack of explanation or contradictory explanations may make symptoms and disability worse, especially in those who are already anxious. All chest pains are important and should be evaluated by a doctor and appropriate referral made where indicated. What follows gives some common causes. It is for awareness only and not a substitute for seeking proper medical care. Acute Chest Pain Severe, sudden chest pain can represent a life-threatening problem If you have symptoms like crushing or squeezing pain in the middle of your chest, neck, left upper arm, back or upper abdomen, sweating, nausea and/ or shortness of breath your pain may be from a HEART ATTACK or MYOCARDIAL INFARCTION � Seek immediate medical help. The membrane covering the heart ( Pericardium) also may also develop an inflammation � PERICARDITIS. This can occur with infections or along with conditions like heart attack, rheumatic heart disease or with kidney failure. The pain extends over a number of days and is relieved by sitting and leaning forward. If you have symptoms of a cold or flu, such as fever, aches, chills, runny nose and/or cough and have a sharp pain in one side of your chest when you take a deep breath your pain may be from PLEURISY, an inflammation of the lining of the lung. If you have a productive cough (greenish, yellowish, or brownish mucus) and fever your symptoms may be from an infection such as PNEUMONIA. These infections are serious and should be diagnosed and treated by a doctor. If you have a cough with minimal clear mucus and it pains when you take a deep breath, you may have VIRAL BRONCHITIS, and your pain may be from PLEURISY or from hard coughing. If you have pressure in your chest along with shortness of breath and numbness around your lips or in your hands or feet, your symptoms may be due to HYPERVENTILATION, an episode of over breathing from exercise or emotions. Lie down, relax and try to slow your breathing. Some doctors suggest breathing into a paper bag held loosely over your nose and mouth. IF YOU ALREADY HAVE A HEART PROBLEM, LUNG CONDITION OR ASTHMA, GO DIRECTLY TO THE HOSPITAL. If the shortness of breath has been increasing gradually you may have a serious problem, such as CONGESTIVE HEART FAILURE, ASTHMA, PULMONARY OEDEMA OR PNEUMOTHORAX. Seek medical help immediately. A pain occurring only with swallowing may be due to irritation of the stomach or esophagus, called GASTRITIS or ESOPHAGITIS, or a HIATAL HERNIA (a weakness in the diaphragm) A painful rash with blisters on your chest or back, is suggestive of a viral infection of the nerves and skin called Herpes Zoster which is caused by chicken pox. If you have back pain that radiates around to the front of your chest it may be from a compressed nerve. This requires further investigation.

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