Chest pain Seminar

Prepared by | Abdullah A. Laftal Group 32 | Medicine 3

Objectives :

define chest pain . state the causes , prevalence management of patient with chest pain

Chest pain :

symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain

Case 1 :

A 53-year-old man was admitted to the hospital .The patient had been well until three months earlier, when he began to have increasingly severe exertional dyspnea, without chest pain.

On the day of admission, he had been at work, lifting and transporting heavy objects, when a sensation of "heaviness"

developed across his chest, accompanied by dyspnea.

In an ambulance en route to this hospital, ventricular fibrillation was discovered, and a single shock resulted in reversion to a normal rhythm.

An electrocardiogram obtained at the time of his arrival at

this hospital showed elevated ST segments in leads V1

through V4, with depressed ST segments in leads II and III

The patient had a 40-pack-year history of cigarette smoking;

he drank little alcohol. He had hypertension and

hyperlipidemia and took medications for both. There was no history of diabetes mellitus or previous chest pain and no family history of coronary disease.

On physical examination :

Temperature was 38.3°C pulse was 85blood pressure was 115/80 mm Hg. The patient was alert and comfortable. The jugular venous pressure was 8 cm of water. Bibasal crackles were present. A grade 1 systolic murmur was heard, with a third heart sound. The abdomen was normaland there was no peripheral edema.

Management :

Oxygen, lidocaine, aspirin, and metoprolol were administered,

the patient was transported urgently to the cardiac catheterization unit.

A coronary angiographic study revealed three-vessel disease,

including complete occlusion of the left anterior descending

artery at its ostium. A stent was placed

DDx :

Pulmonarypneumonia pulmonary embolism (PE)* pneumothorax/hemothorax* empyema pulmonary neoplasm bronchiectasis TB

Cardiac MI angina* myocarditis

Pericarditis cardiac tamponade*

Gastrointestinal Esophageal spasm, GERD, esophagitis, ulceration, achalasia, neoplasm PUD gastritis pancreatitis biliary colic

mediastinallymphoma Thymoma

vascular aortic aneurysm

surface structures costochondritis

rib fracture skin (bruising, shingles)

breast

Chest pain :

DisorderMediastinal

displacementChest wall movement

Percussion noteBreath soundsAdded sounds

ConsolidationNoneReduced over affected area

DullBronchialCrackles

TBNone None NoneNone None

Pleural effusionHeart displaced to opposite side

(trachea displaced only

if massive)

Reduced over affected area

Stony dullAbsent over fluid; may be bronchial at

upper border

Absent; pleural rub may be

found above effusion

PneumothoraxTracheal deviation to

opposite side if under tension

Decreased over affected area

ResonantAbsent or greatly reduced

Absent

PENone None None None Pleural friction rub

An infiltrate in the medial segment of the right middle lobe will obscure the right heart border on the frontal view ,

on the lateral view, is seen as a triangular density radiating from the hilum toward the anterior and lower part of the chest

Group 32 medical student send the gratitude and thanks to Dr.Abdullah Assiri

Dr.Mohammad Younis Khanfor their support .

Also to the organizing committee of SHA 21 scientific session for encourage young researchers