Chest pain

Introduction Chest pain is a common clinical symptom, and there are many reasons, and the location and severity of chest pain are not necessarily consistent with the location and severity of the lesion. Trauma, inflammation, tumors and certain physical and chemical factors caused by tissue damage stimulate the intercostal nerve, phrenic nerve, spinal nerve root and vagus nerve are distributed in the esophagus, bronchus, lung, pleura, heart and aorta nerve shoots, can cause Chest pain. In the identification, you can first analyze which category belongs to, and then identify each cause in this category.

Cause

1. Inflammation: dermatitis, non-suppurative costal cartilage, herpes zoster, myositis, epidemic myalgia, pleurisy, pericarditis, mediastinal inflammation, esophagitis, etc.

2. Visceral ischemia: angina pectoris, acute myocardial infarction, cardiomyopathy, pulmonary infarction, etc.

3. Tumor: Compression or infiltration of primary lung cancer, mediastinal tumor, myeloma, leukemia, etc.

4. Other causes: spontaneous pneumothorax, thoracic aortic aneurysm, dissecting aneurysm, hyperventilation syndrome, trauma, etc.

5. Cardiac neurosis.

an examination

Related inspection

Russell pleural effusion microbiological examination chest drip sound pleural effusion general traits examination pleural effusion microscopy

Physical examination

Chest wall disease can be determined by visual inspection and palpation. The internal organs of the chest must be detailed and detailed, and the unilateral thoracic cavity should be treated to the pleural effusion. Tactile tremors should be seen in pneumonia, and pneumonia or real sound should be considered for pneumonia, pulmonary infarction, lung cancer, and pleural mesothelioma. Percussive drum sounds consider pneumothorax. Patients with angina pectoris and myocardial infarction have normal or enlarged heart, and heart rate increases and auscultation has abnormal findings. Abdominal and crying disorders have corresponding abdominal signs.

Laboratory inspection

Blood routine is routinely examined, and changes in white blood cells can provide a basis. The bacteriological examination of sputum can determine the pathogens of pneumonia and tuberculosis, and exfoliative cytology can help diagnose lung cancer. The laboratory and cytological examination of cerebral and pericardial puncture fluids are beneficial to the diagnosis. The increase of hemoglobin and the increase of serum myocardial enzyme contribute to the diagnosis of acute myocardial infarction.

Device inspection

Electrocardiography is helpful in the diagnosis of angina and acute myocardial infarction. Echocardiography is important for the diagnosis of pericardial effusion and the observation of effusion volume, affirming the diagnosis of valvular disease. Chest X-ray examination plays an important role in the diagnosis of modern chest diseases. Conventional X-ray examination can show images of multiple chest lesions, as a basis for diagnosis of diseases such as pneumonia, tuberculosis, pulmonary infarction, lung cancer, pleural lesions, and pneumothorax. CT examination has high resolution, high diagnostic readiness and sensitivity. CT is a cross-sectional view of the chest section. It shows good effect on the mediastinum, around the diaphragm and subpleural lesions. It often distinguishes blood vessels and fat. Water and various soft tissue density lesions. It is commonly used for the identification of hilar enlargement in the mediastinal lesions, microscopic lesions and pleural lesions in the lungs, and MRI has coronal and sagittal tomography. It also has the advantages of higher resolution of soft tissue in the mediastinum, and can directly display the three-dimensional or even oblique angle of the angle to facilitate the display and localization of the lesion. However, CT and MRI examinations should not be the first choice for chest lesions, and can only be used as a method for further examination. Radionuclide scanning is helpful for the diagnosis of pulmonary infarction, intrapulmonary space-occupying lesions, and myocardial infarction. Cardiac catheterization is of particular value for the diagnosis of congenital and certain acquired cardiovascular diseases, and is also useful for the diagnosis of lung diseases. Fiberoptic bronchoscopy can penetrate deep into the surface and sub-segment bronchus, can be biopsy and brushing under direct vision, do biopsy, bronchoalveolar lavage fluid for microbiology, cytology, immunology, molecular biology examination for lung disease The cause and pathological diagnosis are very helpful. Thoracoscopy is used for the diagnosis of pleural disease, classification of pneumothorax and treatment.

Differential diagnosis

When a clinician diagnoses chest pain, he must master comprehensive clinical data and conduct detailed analysis. First of all, the difference in chest pain originates from the chest wall or intrathoracic organ lesions. If the lesion is confirmed to be from the internal organs of the thoracic cavity, it should be further diagnosed as the location of the lesion (which organ), qualitative and etiology.

Differential diagnosis of chest pain:

Chest pain during pregnancy: Most of the chest pain during pregnancy is clinically manifested by pain in the precordial area or angina pectoris. It is caused by pregnancy-induced myocardial infarction. Pregnancy myocardial infarction is a rare pregnancy complication. (1) Symptoms: Activity tolerance is reduced and breathing is difficult. (2) signs: peripheral edema, jugular vein engorgement, apex beat ectopic. (3) Cardiac auscultation: the first and second heart sounds of the split, the third heart sound (S3) gallop, the jet murmur on the left sternal border, the continuous murmur (from the breast vein murmur), non-pathological diastolic The murmur has reached 10%.

Atypical chest pain: its chest pain symptoms are not typical, clinical chest pain, chest discomfort is a common symptom, and its clinical manifestations vary. Such as stomach pain, neck pain, toothache, sore throat and so on. This pain has a common feature - it happens when you exercise, and it takes a few minutes to rest soon.

Hemoptysis with chest pain: can be seen in lobar pneumonia, pulmonary infarction, tuberculosis, bronchial lung cancer. The lungs should be examined in detail. When the chest X-ray examination has not been carried out, in order to clear the bleeding site as early as possible, the percussion method can be used. For example, when the hemoptysis starts, the breathing sound of one side of the lung is weakened, and the breathing sound of the opposite lung field is good, and the bleeding is often indicated on the side. Physical examination can also support some specific diagnoses, such as mitral diastolic murmurs that are conducive to the diagnosis of rheumatic heart disease. Wheezing sounds appear in the limited lung and bronchial sites, often suggesting intrabronchial lesions, such as lung cancer or foreign bodies. Vascular murmurs in the lung field support arteriovenous malformations. The clubbing is more common in lung cancer, bronchiectasis, and lung abscess. The supraclavicular and anterior scalene muscles are swollen and support metastatic cancer.

Cardiac chest pain: It is caused by heart disease, which can cause myocardial ischemia, hypoxia and injury. Typical cardiogenic chest pain is angina caused by myocardial ischemia in coronary heart disease. It is characterized by post-sternal compression pain and can be diagnosed clinically by electrocardiogram, myocardial enzymology and coronary angiography.

Coronary heart disease angina pectoris is the most common cause of chest pain. It is often caused by fatigue, full meal, and emotional arousal. Generally manifested as left chest compression pain, stuffy pain, dull pain and so on. It often spreads to the back, the inside of the left arm, the teeth, etc., and the duration varies, usually no more than 30 minutes. If the rest or oral nitroglycerin can be relieved after the attack, it can basically be diagnosed.

Pectoralis major muscle pain is generally aseptic inflammatory lesions in the pectoralis major muscle attachment, tension in the pectoralis major muscle, and soft tissue damage outside the spinal canal.

Chest pain caused by esophagitis, hiatal hernia, diffuse esophageal fistula, and esophageal tumor often occurs or worsens when swallowed.

Chest pain accompanied by chest tightness, palpitations, at the same time or before, fever, body aches, sore throat, diarrhea and other symptoms, can be seen in acute myocarditis.

Chest pain after eating is a major manifestation of spontaneous esophageal rupture. The main clinical manifestations were chest pain and upper gastrointestinal bleeding.

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