Precordial pain

Introduction Pain in the anterior region is mainly seen in the fibrin exudation phase of inflammatory changes in acute pericarditis. The visceral layer of the pericardium and the inner surface of the parietal layer are painless, and the outer surface of the parietal layer below the fifth or sixth intercostal level has a distribution of pain fibers of the phrenic nerve, so when the lesion spreads to this part of the pericardium or nearby pleura, mediastinum Pain occurs only when you are sick. Pain in the precordial area is often caused by changes in body position, deep breathing, coughing, swallowing, and lying position, especially when lifting the leg or the left lateral position, and reducing it when sitting or leaning forward. Pain is usually limited to the substernal or anterior region of the chest, often radiating to the left shoulder, back, neck or upper abdomen, even to the lower jaw, left forearm and hand radiation.

Cause

In the fibrin exudation stage of inflammatory changes, the visceral layer of the pericardium and the inner surface of the parietal layer have no pain nerves, and the outer surface of the parietal layer below the fifth or sixth intercostal level has a distribution of pain fibers of the phrenic nerve, so when the lesion spreads to Pain occurs only when this part of the pericardium or nearby pleura, mediastinum or sputum.

an examination

Related inspection

Vascular pseudohemophilia factor electrocardiogram chest radiograph transesophageal echocardiography (TEE)

Pain in the precordial area is often caused by changes in body position, deep breathing, coughing, swallowing, and lying position, especially when lifting the leg or the left lateral position, and reducing it when sitting or leaning forward. Pain is usually limited to the substernal or anterior region of the chest, often radiating to the left shoulder, back, neck or upper abdomen, even to the lower jaw, left forearm and hand radiation.

Differential diagnosis

Differential diagnosis of pain in the precordial area:

In the pre-cardiac area, the pericardial friction sound is heard, and the diagnosis of pericarditis can be established. In the course of a disease that may be complicated by pericarditis, such as chest pain, dyspnea, tachycardia and unexplained systemic venous congestion or enlarged heart, it should be considered as a possibility of pericarditis with exudate. The identification of oozing pericarditis and cardiac enlargement caused by other causes is often difficult. Jugular vein dilatation with odd pulse, weak apex beat, weak heart sound, no valve murmur, early extra tone of diastole; X-ray examination or cardiac phonography shows that the normal contour of the heart disappears, the beat is weak; ECG shows low voltage, ST- The change of T and the prolongation of QT interval are beneficial to the diagnosis of the former. Further, it can be used for ultrasound examination, radionuclide examination and magnetic resonance imaging. Pericardial puncture and pericardial biopsy can help to confirm the diagnosis. The severe pain of non-specific pericarditis resembles acute myocardial infarction, but the former often has a history of upper respiratory tract infection before onset. The pain is significantly aggravated by respiratory, cough or body position changes. Early pericardial friction sounds, as well as serum aspartate aminotransferase and lactate dehydrogenase And creatine phosphokinase is normal, electrocardiogram has no abnormal Q wave; the latter is older, often has a history of angina or myocardial infarction, pericardial friction sounds appear 3 to 4 days after onset, ECG has abnormal Q wave, arch back Changes in ST-segment elevation and T-wave inversion often have severe arrhythmias and conduction block. If the pain of acute pericarditis is mainly in the abdomen, it may be misdiagnosed as acute abdomen. Detailed medical history and physical examination can avoid misdiagnosis. The clinical manifestations of pericarditis of different causes are different and the treatment is different.

1, high risk of precordial pain: angina pectoris, myocardial infarction, pericarditis, myocarditis, pulmonary embolism, spontaneous pneumothorax, aortic dissection.

Angina pectoris: Angina pectoris is a clinical syndrome caused by insufficient blood supply to the coronary arteries, acute myocardial ischemia, and hypoxia. It is characterized by paroxysmal chest compression pain, which can be accompanied by other symptoms. The pain is mainly located in the back of the sternum and can be radiated to the anterior and left upper limbs. It often occurs during labor or emotional excitement for several minutes. It disappeared after rest or with a nitrate ester preparation. The disease is more common in men, most patients are over 40 years old, tired, emotional, full of food, cold, rainy weather, acute circulatory failure are common causes.

Myocardial infarction: similar to angina, but usually more severe and sudden. It usually lasts for more than 30 minutes. Often accompanied by nausea, vomiting, shortness of breath, arrhythmia, hypotension and shock. Rest and sublingual nitroglycerin can only relieve symptoms temporarily or incompletely. Treatment: Take medication, call emergency phone to the hospital.

Pulmonary embolism: Patients with previous unintentional or pulmonary disease have difficulty breathing or have difficulty breathing in patients with previous heart or lung disease. Or signs of right heart failure, common in patients with deep vein thrombosis.

2. Oral precordial pain:

Ectopic pulsation, hyperventilation, pleurisy, rib osteochondritis, herpes zoster, reflux esophagitis, esophageal fistula, peptic ulcer, cholecystitis, pancreatitis, depression. Pain in the precordial area is often caused by changes in body position, deep breathing, coughing, swallowing, and lying position, especially when lifting the leg or the left lateral position, and reducing it when sitting or leaning forward. Pain is usually limited to the substernal or anterior region of the chest, often radiating to the left shoulder, back, neck or upper abdomen, even to the lower jaw, left forearm and hand radiation.

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