Chest pain - is it infarction or not?

The presentation of the chest pain, then, can be a final pathway of a large number of abdominal lesions. What appears to be a indigestion may well prove to be a Myocardial Infarction, or an Heart Attack; what is perceived by the patient to be angina may prove to be indigestion/ the list of possibilities can be narrowed through a careful history and physical examination.

Physical examination may disclose the chest pain to be reproducible with palpation, respiration, or certain motions. History might indicate the chest pain was associated with inhalation of certain vapors, was slow or rapid in onset, or began after a cough or fever. Careful attention should be directed toward family history and the review of major coronary risk factor such as Hypertension, cigarette smoking, obesity, diabetes mellitus, and hypercholesterolemia.

The characteristics of the chest pain are important in developing a differential diagnosis. Patients with chest pain should be questioned regarding several factors relating to their pain:

The chest pain should be described in terms of PQRS as follows:

• Palliative-provocative factors - What makes it better? Worse? What initiates the pain?
  
• Quality - pressure, sharp, dull, aching, squeezing, burning, tearing
  
• Region and radiation - where does it starts? Does it irradiate? Where?
  
• Severity - is it severe, mild or moderate?
  
• Timing - does it start right away? Is it intermittent or continuous? Is there a lag period? How long does it last?
  

Also, I thought you may be interested in reading also the symptoms of the chest pain

The Symptom of Chest Pain

The symptom of chest pain in the retrosternal or precordial region is indicative of pain in T1 to T6 dermatome pattern. This dermatome patterns cover the area of the chest and back from the upper sternum (T2) to below, the xiphoid process (T6). The sensory distribution travels down the anteromedial surface of the arms, with T1 more distal (as you can see in the picture below).

The sensory input from this levels interconnects in the spinal cord. Visceral sensation from the structures innervated by these nerves will produce a deep and poorly localized pain indistinguishable in source of origin

T1 to T4 receive innervation from thoracic organs. The visceral pain produced usually lies retrosternal or in the precordium. Such a pain may travel down T1 or T2 to the arm or up to the neck. T5 and T6 supply visceral sensation of the lower thoracic organs, diaphragm, and upper abdominal organs; these include the gallbladder, pancreas, stomach, duodenum, and their peritoneal surfaces. The pain produced here may be maximal in the xiphoid or midback regions, but can extend to any area of the T1 or T6 dermatomes.

Frequently, irritation of these pathways causes nausea and vomiting, especially of the lower dermatomes.

Chest Pain in Heart Attack

The patient arriving at the Emergency Department with the chief complaint of Chest Pain is familiar to all physicians. The occurrence of such pain is source of fear both in those treating and those being treated. Though Chest Pain may be cardiac in origin, it may also be caused by any one of a spectrum of diseases and only through a thorough history and careful examination can a diagnosis be made

In our next posts I will debate and present clinical information about Myocardial Infarction (known also, as Heart Attack.) Your questions and comments are welcomed also, please post them and we’ll try to answer them. We thank you for your time and for your attention!

Continue reading our heart infarction blog