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Chest Pain

Chest Pain Differentials

QuestionAnswer
Angina pectoris: What is the process? Temporary myocardial ischemia, usually secondary to coronary atherosclerosis
Angina pectoris: Location? retrosternal or across the anterior chest, sometimes radiating to the shoulders, arms neck, lower jaw, or upper abdomen
Angina pectoris: What is the quality? Pressing, squeezing, tight, heavy, occasionally, burning
Angina pectoris: What is the severity? mild to moderate, sometimes perceived discomfort vs pain. Usually 1-3 min but up to 10 min. Prolong episodes up to 20 min
Angina pectoris: Aggravating factors? exertion, especially in the cold, meals, emotional stress. May occur at rest
Angina pectoris: Relieving factors? rest, nitroglycerin
Angina pectoris: Associated symptoms? sometimes dyspnea, nausea, sweating
Myocardial infarction: What is the process? Prolong myocardial ischemia, resulting in irreversible muscle damage or necrosis
Myocardial infarction: Location and quality? Same as angina
Myocardial infarction: Quality? often but not always a severe pain, may last 20 min to several hours
Myocardial infarction: Associated symptoms? dyspnea
Pericarditis: What is the process? Irritation of the parietal pleura adjacent to the pericardium
Pericarditis: Location? retrosternal or left precordial, may radiate to the tip of the shoulder
Pericarditis: What is the quality? severe, persistent, sharp knifelike type pain
Pericarditis: Factors that aggravate? breathing, changing positions, cough, lying down, sometimes swallowing
Pericarditis: Factors that relieve? sitting forward may relieve it
Pericarditis: Associated symptoms? seen in autoimmune disorders, post;myocardial infarction, viral infection, chest irradiation
Dissecting aneurysm: What is the process? a splitting within the layers of the aortic wall, allowing passage of blood to dissect a channel
Dissecting aneurysm: Location? anterior chest, radiating to the neck, back or abdomen, dyspnea and sometimes loss of consciousness
Dissecting aneurysm: Quality? very severe, abrupt onset ripping, tearing type pain that peaks early and persists for hours or more
Dissecting aneurysm: Factors that aggravate? hypertension
Dissecting aneurysm: Associated symptoms? if thoracic, hoarseness, dysphagia, also syncope, hemiplegia, paraplegia
Tracheobronchitis: What is the process? inflammation of trachea and large bronchi
Tracheobronchitis: Location? upper sternal or on either side of the sternum
Tracheobronchitis: Quality? mild and moderate burning
Tracheobroncnitis: Factors that aggravate? coughing, it's also an associated symptom
Tracheobronchitis: Factors that relieve? lying on the involved side may relieve the pain
Pleuritic pain: What is the process? inflammation of the parietal pleura, as in pleurisy, pneumonia, pulmonary infarction, or neoplasm
Pleuritic pain: Location? over the chest overlying the , sharp, knifelike, severe, persistent
Pleuritic Pain: Factors that aggravate? deep inspiration, coughing, movements of the trunk
Reflux esophagitis: What is the process? inflammation of the esophageal mucosa by reflux of gastric acid
Reflux esophagitis: Location? retrosternal, may radiate to the back
Reflux esophagitis: Quality? mild to severe, burning, may be squeezing
Reflux esophagitis: Factors that aggravate? large meal; bending over; lying down
Reflux esophagitis: Factors that relieve? antacids, sometimes belching
Reflux esophagitis: Associated symptoms? sometimes regurgitation, dysphagia
Diffuse Esophageal Spasm: What is the process? motor dysfunction of the esophageal muscle
Diffuse Esophageal Spasm: Location? Retrosternal, may radiate to the back, arms and jaw
Diffuse Esophageal Spasm: Quality? mild to severe squeezing pain that varies in timing
Diffuse Esophageal Spasm: Factors that aggravate? swallowing of food or cold liquid, emotional distress
Diffuse Esophageal Spasm: Factors that relieve? sometimes nitroglycerin
Diffuse Esophageal Spasm: Associated symptom? dysphagia
Chest wall pain/Costochondritis: What is the process? it's an inflammatory process but usually has no definite cause. Repeated minor trauma to the chest wall, overuse of the arms, or viral respiratory infections can cause pain
Chest wall pain/Costochondritis: Location? often below the left breast or along the costal cartilages
Chest wall pain/Costochondritis: Quality? stabbing, sticking, or dull aching pain that varies in severity and is fleeting to hours and days
Chest wall pain/Costochondritis: Factors that aggravate? movement of chest, trunk, arms
Chest wall pain/Costochondritis: Associated symptom? local tenderness
Anxiety: What is the process? through mechanisms that directly affect coronary vasculature. Both autonomic activation and hyperventilation (via alkalosis) can lead to coronary artery spasm
Anxiety: Location? precordial, below the left breast of across the anterior chest
Anxiety: Quality? stabbing, sticking, or dull aching pain that varies in severity and is fleeting to hours and days, same as with chest wall pain
Anxiety: Factors that aggravate? may follow effort, emotional stress
Anxiety: Associated symptoms? breathlessness, palpitations, weakness, anxiety
Created by: cljohnson2000