Chest Pain Differentials

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Chest Pain Differentials

 

In evaluating chest pain, the first task--not always easy--is to

differentiate respiratory pain from pain related to other systems.

The nature of the pain and the circumstances of its development

usually distinguish angina or the pain of MI.

 

Pain associated with a dissecting aneurysm may be more difficult to

discern from the history alone. However, physical examination, x-rays

(sometimes including CT or angiograms), and ECGs usually make the

distinction obvious. Esophageal pain usually has characteristics

relating it to eating or acid regurgitation.

 

Most noncardiac chest pain arises from the pleura or the chest wall.

Pleuritic pain is typically made worse by deep breathing or coughing

and may be controlled by immobilization of the chest wall; eg, the

patient may hold his side, avoid deep breathing, or suppress his

cough. The patient can usually identify the site of pleuritic pain.

Over time it may move from one site to another. If a pleural effusion

develops, the pain may disappear as the inflamed pleural surfaces are

separated. A friction rub is often associated with pleuritic pain,

but either may occur alone.

 

Pain arising from the chest wall may be exacerbated by deep breathing

or coughing, but it can usually be distinguished by localized

tenderness. Although some tenderness may be present with pleuritic

pain (eg, in pneumococcal pneumonia), it is usually slight, poorly

localized, and elicited only by deep pressure. Chest wall trauma or a

broken rib is often obvious from the history, but torn muscle fibers

or even a rib fracture can result from severe coughing. A tumor

infiltrating the chest wall may cause local pain or, if it involves

intercostal nerves, referred pain. Herpes zoster, before the eruption

appears, may present as puzzling chest pain.

 

Pain arising from other respiratory structures is usually less easy

to characterize than pleuritic pain. A deep-seated, vague lung ache

occurs occasionally with a lung abscess, tuberculous cavity, or giant

bulla and may arise from stretch receptors associated with pulmonary

vessels. A rapidly growing mass in the mediastinum or lung

occasionally causes a poorly localized ache. Physical examination and

chest x-rays can usually determine the cause.

 

Chest pain should never be dismissed. See your primary care physician

when experiencing any kind of chest pain.

 

 

Andrew Pacholyk LMT, MT-BC, CA

Peacefulmind.com

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