PATIENT EVALUATION AND PLAN (Medical Students should be Check )

PATIENT EVALUATION AND PLAN

Always rule out life threatening conditions such as myocardial infarction, aortic dissection, pulmonary embolism and pneumothorax.

History is very important, ask about risk factors for MI such as hypertension, smoking, diabetes, dyslipidemia and strong family tendency. Decide whether the pain is typical or atypical. For pulmonary embolism ask about prolonged bed rest, DVt, use of oral contraceptives and valvular heart disease. History of heartburn and food regurgitation may indicate reflux esophagitis. Ask about any emotional problem. Sudden chest pain with shortness of breath, especially in patients of asthma, tuberculosis and COPD may indicate pneumothorax. While examining the patient auscultation of lung and heart may be helpful. Local tenderness indicates musculoskeletal disorder.

CHEST PAIN DUE TO PERICARDITIS:

• Visceral pericardium and most of the parietal pericardium is insensitive to pain, therefore pain associated with pericardium is believed to be due to inflammation of adjacent parietal pleura. Pain due to non-infectious causes such as MI or uremia is mild while infectious pericarditis causes more sever pain due to spread of infection to the neighboring pleura.
• Pain due to pericarditis may be felt at the tip of the shoulder, neck, anterior chest, upper abdomen or back.
• Pericardial pain is aggravated by cough and deep inspiration because of pleural irritation, change in posture and swallowing. It become sharper and more left-sided in supine position and milder when patient sits upright and leans forward.
• In some patients pericardial pain is steady retrosternal discomfort mimicking the pian of myocardial infarction.

CHEST PAIN DUE TO PULMONARY EMBOLISM:

Infarction of a lung that is adjacent to the pleura commonly irritates pleural surface and causes chest discomfort, it may resemble the pain of myocardial infarction.

CHEST PAIN DUE TO ESOPHAGEAL CAUSES:

Esophageal spasm due to reflux esophagitis causes squeezing pain that mimics pain of MI. it may have similar pattern of distribution. History of heartburn and food regurgitation are important clues. A number of children come to cardiac emergency with chest pain that is usually due to esophageal spasm as result of eating groundnut in the form of sweat supari, pan or gutca. We can only pray to God to save our children as the government is not interested to stop such health-killing business. 

                                                                                                    Dr. Inam  Danish