Pain

Published on 23/05/2015 by admin

Filed under Internal Medicine

Last modified 23/05/2015

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Chest Pain

Chest pain is a common presenting symptom of disorders that can range from trivial to life-threatening.

History

Character

The character of angina is tight and crushing, while the pain from aortic dissection has a tearing quality. Oesophageal reflux may be described as a burning pain, and peptic acid-related pain tends to be deep and gnawing.

Location

The pain from angina and oesophageal reflux may be located retrosternally, and they both can radiate to the jaw or down into the left arm. The pain from pericarditis may be centrally located and radiate to the shoulders (trapezius ridge pain). Pain from aortic dissection often radiates into the back and occasionally into the abdomen (depending on the extent of the dissection). Pulmonary pain can be located anywhere in the thorax.

Precipitating factors

Angina may be precipitated by effort, a defining characteristic. Other known precipitants of angina are emotion, food and cold weather. If angina occurs at rest for more than 20 min, it should be treated as a myocardial infarction until proven otherwise. Oesophageal reflux is often related to meals and precipitated by changes in posture, such as bending or lying. Pain originating from pericarditis and pulmonary origin is often pleuritic, i.e. worse on inspiration; however, musculoskeletal pain can also be worse on breathing due to movement of the thorax.

Relieving factors

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