CHEST PAIN DUE TO MUSCULOSKELETAL DISORDERS:

CHEST PAIN DUE TO MUSCULOSKELETAL DISORDERS:

Localized tenderness is common. Pain may be sharp, lasting for few seconds or it may be dull that persists for hours or even days. Pain is variable in site and intensity; there is no definite pattern. It may vary with posture or movement, but does not cease instantly on rest. Pain due to cervical spondylosis is very common.

Local tenderness over rib or costal cartilage is usually present.

CHEST PAIN DUE TO AORTIC DESSECTION:

Hypertension and Marfan’s syndrome are the most common predisposing factors. Patient is usually old presenting with severe tearing chest pain radiating to interscapular region, not responding to anti-anginal treatment. Pulse may be unequal. Features of cardiac temponad or acute aortic regurgitation may be present. Chest x-ray may show wide mediastinum. Transesophageal echocardiogram (TEE), CT or MRI are helpful in diagnosis.

CHEST PAIN DUE TO EMOTIONAL CAUSES:

Emotional disorders may cause chest discomfort in the form of chest tightness, lasting for half and hour or more that in unrelated to exertion. It may be sharp and very vrief and located near the left nipple. This type of pain is also called “precordial catch” effort syndrome or Da Costa’s syndrome”. Emotional strain may be evident or not. This type of pain is common in females of our society. However never underestimate the young population because this chest pain may be a real problem as a result of mitral valve prolapse (MVP), aortic stenosis or hypertrophic cardiomyopathy.

Therefore always rule out all possibilities before declaring pain due to emotional disturbance, hysteria or malingering.

 

Written by

Dr. M. Inam Danish