Chest pain is the symptom that people most request for emergency help in society. Every year, millions of patients apply to emergency departments with this complaint. It needs to be evaluated very carefully and urgently as it may be the first symptom of a sudden heart attack. Patients often associate chest pain with stomach complaints and less important etiological factors, leading to delays in diagnosis. However, it is known that a heart attack can occur without chest pain.
Another common cause of chest pain is panic attack. In this way, many patients apply to emergency services thinking they are having a heart attack. It is important to direct the treatment in these patients after cardiac causes are excluded. Apart from these, chest pain may arise from the musculoskeletal system, lungs, esophagus and nerves.
Causes of Chest Pain:
Acute Myocardial Infarction. :
It is a clinical picture that occurs with ischemia of the heart muscle secondary to a disorder in coronary circulation. It is characterized by severe pain lasting more than a few minutes. Pain can also radiate to the back, neck, jaw, shoulders and arms (especially the left). Electrocardiogram, cardiac enzymes and radiological examinations are used in its diagnosis. Emergency treatment is required. In addition to thrombolytic and other treatment approaches that open the coronary arteries, cardiopulmonary resuscitation should be applied when necessary. Strong opioids, especially morphine, are effective in treating pain. In addition, nitroglycerin and beta blockers help control pain by reducing myocardial O2 requirement.
Angina pectoris:
It is a common symptom of coronary artery disease. Pain can be in the chest, arms, shoulders and back. exhaust It has the character of increasing with inactivity and decreasing with rest. Symptoms may be hidden in diabetic patients. Apart from pain, it may manifest itself with a feeling of discomfort in the chest, a feeling of pressure, a feeling of suffocation and blockage. Electrocardiogram, coronary arteriogram and nuclear stress tests are helpful in diagnosis. It responds to nitroglycerin.
Pericarditis:
It is the inflammation of the pericardium. It may occur secondary to infection, trauma, collagen tissue diseases, malignancies and renal failure. The pain is sharp and stinging in the middle of the chest. The pain gets worse when the patient lies down and eases when he sits or stands up. Pain may radiate to the shoulders and neck. Tachypnea and dyspnea also accompany the pain. Diagnosis is made by physical examination, ECG and chest radiography. Nonsteroidal anti-inflammatory drugs are effective in pain palliation.
Dissecting aortic aneurysm:
It is a life-threatening condition that occurs with sudden and severe pain. Dissection in the ascending aorta causes anterior or posterior chest pain, while dissection in the descending aorta causes more back pain. Nausea, vomiting and sweating are common symptoms. Medical treatment includes beta blockers to reduce heart rate and vasodilator approaches to reduce blood pressure. Emergency or elective surgery is planned in necessary cases.
Other heart-related conditions that cause chest pain:
Aortic stenosis, aortic regurgitation, mitral valve prolapse, hypertrophic cardiomyopathy.
Anxiety and panic attack:
In general, anxiety attack is the name given to the milder type of panic attack. When panic is accompanied by irrational feelings such as extreme fear, it is more appropriate to call it a panic attack. Panic with a single panic attack The disorder cannot be diagnosed. In addition, panic attacks may occur in some anxiety disorders such as phobias. Mental symptoms are complaints such as “I am losing control”, “I am going crazy”,“I am losing my mind”or “I am going to die” , physical symptoms may manifest as shortness of breath, sweating and dizziness along with chest pain.
Esophagitis:
It is an acute or chronic inflammation of the esophagus. Etiological factors include gastroesophageal reflux, ingestion of corrosive chemicals, drugs and microorganisms. It is a burning pain felt behind the sternum. Difficulty in swallowing and pain with swallowing may occur. Pain relief and cause-oriented treatment approaches should be planned.
Pneumothorax:
It is a clinical picture characterized by lung collapse due to the presence of air in the pleural cavity. It can occur spontaneously or due to trauma and iatrogenic reasons. It manifests itself with sudden, unilateral chest pain, referred pain in the shoulder and abdomen, and shortness of breath. Since a small amount of air will be resorbed, only monitoring may be sufficient. If there is too much air to be resorbed, needle aspiration and catheter or tube insertion may be necessary. Oxygenation and pain relief are also important components of the treatment.
Peptic ulcer:
It occurs with inflammation of the stomach and duodenum. The underlying cause is reported to be Helicobacter pylori bacterial infection or some medications used (especially nonsteroidal anti-inflammatories) and the treatment approach includes antibacterial treatment and discontinuation of related medications. Abdominal pain, which usually begins 2-3 hours after a meal, may also occur while fasting and may occur after eating or taking anti-inflammatory drugs. It has a lightening character with acids. Pain may spread to the front, lower and middle parts of the chest, as well as the epigastrium. Diagnosis is made endoscopically and radiologically. In perforated peptic ulcers, there is severe epigastric pain radiating to the lower chest along with hypotension. Its treatment is surgery.
Pulmonary embolism:
It is the blockage of the pulmonary artery and its branches, usually with thrombus material. Common causes are deep vein thrombosis, surgery, trauma and fractures. Chest pain occurs in more than 90% of cases. Dyspnea, tachypnea, hemoptysis, cyanosis, tachycardia, anxiety and syncope may also accompany the clinical picture. Treatment is bed rest, anticoagulants, streptokinase and oxygenation.
Pancreatitis:
It is pancreatic inflammation that occurs secondary to chronic alcohol use or biliary stones. In acute pancreatitis, there is severe epigastric pain with a feeling of retrosternal distress. The pain radiates to the lower left part of the chest and is not affected by exertion. Severe abdominal muscle spasm, hypotension and hypoventilation may occur together. All opioids can cause increased tone in the sphincter of Oddi and increased pressure in the biliary ducts. For this reason, nonsteroidal anti-inflammatory drugs may be preferred in the treatment of pain.
Costochondritis (Tietze syndrome):
It is a disease caused by inflammation of the costal cartilages. It goes away with localized pain and tenderness. It is a self-limiting picture. Cold application, paracetamol and nonsteroidal anti-inflammatory drugs can be used for pain palliation.
Herpes zoster infection:
It is a common infection, especially over the age of 50. It shows symptoms depending on the level at which the spinal roots are infected with varicella zoster virus. Early treatment approach prevents future developments It can prevent the development of rhetic neuralgia. When pain persists for more than 3 months, it is defined as postherpetic neuralgia. This picture develops more in immunosuppressed and elderly people. The pain is neuropathic in character. It can be stinging, flammable or lightning-like. In particular, starting antiviral treatment within the first 72 hours reduces pain and also reduces the possibility of developing postherpetic neuralgia. Antidepressants (amitriptyline), anticonvulsants (carbamezapine, gabapentin, pregabalin) and opioids (morphine, fentanyl) can be used in pain treatment.
< br /> Lung cancer:
It is one of the most common cancers. It manifests itself with symptoms such as chronic cough, hemoptysis, chest pain, fever, recurrent pneumonia-bronchitis, weight loss, and fatigue. Smoking and tobacco use are the most common factors in its etiology. Cancer-related pain may develop directly due to tumor invasion or may develop secondary to metastases or their pressure on neural tissue. Pain treatment is also planned according to these factors. First of all, it is of great importance to perform tumor-directed surgery, chemo and radiotherapy. In addition, medical and interventional pain treatment methods have a place in pain palliation. Nonsteroidal anti-inflammatories, weak and strong opioids can be used in the treatment of pain, and antidepressants and anticonvulsants can be added to pain with a neuropathic component. Interventional and surgical methods that can be applied; They are open or percutaneous cordotomy, spinal opioid applications, cervicothoracic sympathetic blocks, dorsal root entry zone lesions, stereotactic mesencephalotomy or thalamotomy, posterior spinal rhizotomy and cingulotomy.
Postmastectomy and postthoracotomy syndromes:
Intercostal nerves or bras during breast and lung surgery These are neuropathic pain syndromes that occur due to damage to the chial plexus. The character of the pain is burning and stinging. Antidepressants, anticonvulsants, non-opioids and opioids can be used in the treatment. Spinal opioid treatment can be applied in unresponsive cases.
Subphrenic abscess:
Subdiaphragmatic abscess with pus leaking from perforated abdominal organs and inflammation in the diaphragm leads to its formation. It is characterized by stinging, sharp pain in the lower part of the chest and often radiating to the shoulder. Dyspnea, fever, and pleural effusion may also be observed. In conclusion, there are many different factors that can cause chest pain. Treatment approaches vary greatly. Therefore, in order to make the correct diagnosis, it is an appropriate approach to evaluate the character, spread and duration of the pain and start urgent treatments as soon as possible.
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