It is a common challenge for clinicians in the doctor's office or emergency room to deal with chest discomfort (pain). The first thing that the doctor (and the patient) thinks of when someone is experiencing chest pain is ischemic - anginal pain, that is, pain related to coronary disease, or angina pectoris (stable or unstable) and acute myocardial infarction.
In terms of both the characteristics of the pain itself as well as the cause of the pain, there are different types of chest pain. According to research, the most common reason for people to delay going to the doctor is the realization that the chest pain is simply a severe pain, followed by general weakness, or the feeling that they are ill.
There are cases when chest pain severity is not related to the severity of the disease, pathoanatomical substrate, or pathophysiological sequence of events.
CARDIAC ISCHEMIC CHEST PAIN (ANGINOS PAIN)
The condition occurs when there is inadequate supply of nutrients and oxygen to the heart muscle.
The reduction in oxygen supply to the heart muscle is primarily caused by coronary disease, which affects the supply of oxygen to the heart muscle. In addition to narrowing coronary arteries (arteries that supply oxygen and nutrients to the heart muscle), coronary artery wall spasms may also occur (under various circumstances such as psychological excitement, fear, neurotic disorders, nicotine poisoning).
Angina pain usually has strict characteristics: quality, duration, localization and propagation of pain, as well as accompanying symptoms. A dull, burning, burning pain described as squeezing, pressing, or burning; It can last up to 10 minutes continuously; it can also last longer; An area larger than a palm width behind the sternum; The patient points to the sternum with his fist when he has Levin's sign; Often it spreads to the neck, shoulders, arms, back (between the shoulders) or stomach (but never below the navel); As a result, sweating ("cold sweat"), vomiting, nausea, and sometimes loss of consciousness follow; CARDIAC NON-ISCHEMIC PAIN The following situations can lead to it: In a dissecting aneurysm of the aorta, the pain is usually sudden, sharp, splitting, and tears, and can spread to the back and abdomen, but may lead to dissection.
There may also be neck pain if the ascending aorta is affected, and if the dissection occurs at the mouth of the coronary artery, more often the right one, there may be pain of dissection and ischemia. The intensity increases with duration.
About 20% of patients experience unconsciousness. Breathing, moving, applying pressure, and massaging do not change its intensity. This disease usually causes stabbing pains that intensify when you breathe air, but its more striking symptoms include sudden onset, intense suffocation, rapid breathing, fast heart rate, blue discoloration of the lips and peripheral parts of the body, and a fall in blood pressure based on the severity.
Usually it occurs after prolonged lying down, long trips, orthopedic or other surgical operations, or when there is a family history of tumors or thromboembolic diseases. Immunement of the heart muscle (acute myocarditis) or the heart tissue (pericarditis): It is sharper and usually changes with respiration.
A differential diagnosis can be made with additional anamnesis (especially information about previously untreated infections), physical examination, ECG, echocardiogram, and laboratory analyses.