Chest compression pain

Introduction Angina is a group of clinical syndromes in which chest compression pain caused by insufficient blood supply to the coronary artery lasts for several minutes. There is a contradiction between the blood supply of the coronary artery and the blood supply of the myocardium. The blood flow of the coronary artery cannot meet the needs of myocardial metabolism, causing acute and temporary ischemia and hypoxia of the myocardium, that is, angina pectoris. Angina pectoris often manifests as pain in the chest area, mainly in the posterior sternal or anterior region of the sternum, and radiates to the left shoulder and left forearm, and so on, which can explain many different types of angina.

Cause

The cause of oppressive pain in the chest

The principle of angina pectoris is still inconclusive, and its controversy can be traced back to the beginning of this century. COLBECK80 years ago suggested that the pain of myocardial ischemia was caused by the stretch of the ventricular wall (ie, the mechanical hypothesis). After 20 years, Lewis believed that the pain was related to certain substances released by the local myocardial (ie, the chemical hypothesis). The two factions have been debated for decades. It seems that the mechanical hypothesis is unlikely to explain angina. On the contrary, the chemical hypothesis has been confirmed by experiments. Experiments have shown that the pain-causing substances produced by myocardial ischemia and hypoxia include adenosine, lactic acid, potassium ions, hydrogen ions and plasma kinins. The receptors of the heart are mainly sympathetic nerve endings. The distribution of these nerve endings on the internal organs is far less than that of the body receptors, mainly distributed at the proximal end of the small coronary artery. When myocardial ischemia and hypoxia occur, locally produced metabolic pain-causing substances stimulate these receptors, triggering nerve impulses of pain, and are transmitted to the corresponding spinal segments through the 1-4th thoracic sympathetic ganglia, and transmitted to the brain through the afferent nerves. The cortex produces pain. The pain caused by the internal organs is often reflected in the skin area distributed by the spinal nerves in the corresponding segments of the spinal cord. Therefore, the pain in the chest area is often reflected in the angina pectoris, mainly in the posterior sternal or anterior region, and is radiated to the left shoulder and left forearm. And so on, can explain many different types of angina.

Mechanical stimulation of the heart does not cause pain, but myocardial ischemia and hypoxia cause pain. When there is a contradiction between the blood supply of the coronary artery and the blood supply of the myocardium, the coronary blood flow cannot meet the needs of myocardial metabolism, causing acute, temporary ischemia and hypoxia of the myocardium, that is, angina pectoris.

an examination

Related inspection

Thoracic chest CT examination

Examination of chest chest compression pain

According to the typical characteristics and signs of seizures, the relief with nitroglycerin, combined with age and the predisposition to coronary heart disease, except for angina caused by other causes, can generally establish a diagnosis. At the time of onset, ECG examination showed that in the lead-based lead, the ST segment was depressed, the T wave was flat or inverted (variant angina was associated with ST-segment elevation), and gradually recovered within a few minutes after the onset. Patients with no changes in ECG may be considered for stress testing. If the episode is atypical, the diagnosis depends on the observation of the efficacy of nitroglycerin and the changes in the electrocardiogram at the time of onset; if it is still undiagnosed, the electrocardiogram, ECG load test or continuous monitoring of 24-hour Holter can be performed multiple times, such as positive changes in ECG or load test. Can also be diagnosed when induced angina pectoris. Those who have difficulty in diagnosis can be used for radionuclide examination or for selective coronary angiography. Selective coronary angiography is required for patients undergoing surgical treatment. Intracoronary ultrasonography can show lesions in the wall and may be more helpful for diagnosis. Coronary angioscopy can also be considered.

Differential diagnosis

Symptoms of confusing symptoms of chest compression pain

(A) cardiac neurosis: patients with this disease often complain of chest pain, but for a short (several seconds) of tingling or more persistent (hours) of pain, patients often like to take a deep breath or sigh from time to time Breathe. The area of chest pain is mostly near the apex of the left breast, or changes frequently. Symptoms often appear after fatigue, while at the time of fatigue, mild activity is reflexive comfort, sometimes it can tolerate heavier physical activity without chest pain or chest tightness. Containing nitroglycerin is ineffective or "effective" after more than 10 minutes, often accompanied by symptoms of palpitations, fatigue and other nervous failure.

(B) acute myocardial infarction: the pain of this disease is similar to angina pectoris, but the nature is more intense, the duration can be several hours, often accompanied by shock, arrhythmia and heart failure, and fever, containing nitroglycerin can not make it ease. In the electrocardiogram, the ST segment of the lead to the infarction site is elevated and has an abnormal Q wave. Laboratory tests showed that white blood cell counts and serological tests showed an increase in creatine phosphokinase, aspartate aminotransferase, lactate dehydrogenase, myoglobin, myosin light chain, and increased erythrocyte sedimentation rate.

(C) Syndrome X (syndrome X): This disease is caused by small coronary artery systolic dysfunction, with recurrent angina pectoris as the main performance, pain can also occur at rest. At the time of onset or after the load, the electrocardiogram can show myocardial ischemia, the myocardial perfusion can show defects, and the echocardiogram can show segmental wall motion abnormalities. However, this disease is more common in women, the risk factors of coronary heart disease are not obvious, the pain symptoms are not typical, the coronary angiography is negative, the left ventricle is not hypertrophic, the ergometrine test is negative, the treatment response is unstable and the prognosis is good, then the crown Heart disease is different from angina.

(4) Angina caused by other diseases: including severe aortic stenosis or regurgitation, coronary arteritis caused by rheumatic fever or other causes, coronary stenosis or occlusion caused by syphilitic aortitis, hypertrophic cardiomyopathy, congenital Coronary artery malformations and other causes angina pectoris, according to other clinical manifestations to identify.

(5) Intercostal neuralgia: The pain of this disease often involves 1 or 2 intercostal spaces, but it is not necessarily limited to the front chest. It is stinging or burning, mostly persistent rather than seizure, coughing, forced breathing and The rotation of the body can aggravate the pain, there is tenderness along the nerve path, and there is local pain during the lifting of the arm, so it is different from angina.

In addition, atypical angina needs to be differentiated from chest and abdomen pain caused by esophageal lesions, sputum, ulcer disease, intestinal disease, and cervical spondylosis.

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