Q: What are the symptoms of pulmonary embolism?Ī: For pulmonary embolism, it’s not as well defined in terms of features of the chest pain, but some of the things that would point towards that would be if you have a history of swelling in just one of your legs, because the most common cause of a pulmonary embolism is a blood clot travelling from the veins of the legs up to the lungs.
An aortic dissection is literally a tearing of the vessel so you feel that tear or knife-like pain going down your back along with the chest pain. Your aorta comes in an arch forward and then goes down your back. Q: What are the symptoms of aortic dissection?Ī: Something like an aortic dissection typically presents with chest pain that’s underneath the sternum, where your heart is located, but also very characteristic like a tearing or knife-like pain in the back. Women tend to have a lot of atypical angina or other symptoms like nausea, lightheadedness or bloating, and that can be their equivalent of angina, so a lot of people might not pick up on that. So women tend to not have typical angina. This typical chest pain and typical angina syndrome were defined historically based on large studies of men. The big caveat to this is that all of these symptoms, these 3 characteristics of typical angina, were based on studies that were done in the past and really looked predominantly at men. If you have 2 of them, then it's kind of in the gray zone and in between. If you only have one of those, then we think that there's low likelihood that you have coronary artery disease. That by definition means that you have obstructive coronary artery disease. If you have all three of those, we call that typical chest pain or typical angina. Q: What are some concerning symptoms of chest pain?Ī: The ones that are concerning are if the chest pain is substernal (it’s underneath the center of your chest where the is heart located), if it’s provoked by exertion or stress, and if it’s relieved by rest or nitroglycerin tablets. Serious types of chest pain Typical angina symptoms: 3 symptoms to watch out for if it’s relieved by a nitroglycerin tablet.Ī yes to any of the three questions would suggest that the patient’s chest pain is related to their heart not getting enough blood flow, which could indicate a heart attack.if it's right under the chest under the breast-bone.Afterwards, I would ask three other questions to tease out the true nature of the pain they're having: For example, if someone is very old, has smoked their whole life, has a history of high blood pressure and high cholesterol, they're automatically at a much higher likelihood of having some of those “can’t miss” conditions just by the nature of their risk factors. Some of the questions are more historical and demographic. There are a few key questions you could ask to figure out if someone has one of those four “can’t miss” conditions. They include things like an ongoing heart attack, a pulmonary embolism (blood clot in the lungs), a pneumothorax (collapse of the lungs), and an aortic dissection (a tear in the aorta which is the biggest blood vessel in the body).
Q: Which causes do you think about first when a patient comes in with chest pain?Ī: I start by thinking about the “can’t miss” diagnoses that can cause people to die within a day. The diagnoses that are fatal within one day There are a few really key characteristics that could help categorize someone's chest pain as something acute that require you to mobilize a ton of resources right away versus other things that are not life threatening even if they may be causing the patient's chest pain and discomfort. Q: Say a patient comes in with tightness in chest, what would be on your mind?Ī: Chest tightness or pain can be caused by a really broad number of things (also see 23 Reasons Why You Have Random Chest Pain). Updated August 4, 2020.Tightness in chest, first thoughts? First thoughts when a patient comes with tightness in chest
National Library of Medicine: MedlinePlus. Chest Pain. Prevalence of neuro-musculoskeletal pain and dysfunction in open-heart surgical patients preoperatively and at 6 and 12 weeks postoperatively: a prospective longitudinal observation study.
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