Chest Pain

Angina

Character

Crushing, heaviness, discomfort or choking sensation.

Duration

usually short (typical duration 2 – 10 min).

Severity

Graded by New York Heart Association Classification (NYHAC) according to activity to the following:Class I : angina or dyspnea during unusually intense activity.Class II : angina or dyspnea during ordinary activity.Class III : angina or dyspnea during less than ordinary activity.Class IV : angina or dyspnea at rest

Site and radiation

Retrosternal area or the throat, central and may radiate to the jaw or the arms, rarely travel below umbilicus.

Aggravating and relieving factors

Aggravating factors:Stress ( as exercise, emotional excitement and cold weather).Relieving factors: A) Rest. B) Sublingual nitrate relief the pain within minutes.

Associated symptoms

Investigation

Treatment

Subtopic

MI

Character

Same of angina

Duration

usually long (typical duration 30 min or more).

Severity

More severe and occur at rest.

Site and radiation

Same of angina.

Aggravating and relieving factors

Often no obvious precipitant (not necessarily precipitated by exertion).- Not relieved by rest or nitrates.

Associated symptoms

dyspnea, sweating, anxiety, nausea, and faintness.

Investigation

Troponin T and troponin ICreatine kinaseRenal function and electrolytesBlood glucoseFull blood countSerum cholesterolElectrocardiography

Treatment

• Definition: chest pain made worse by inspiration.
• Cause: movement of the inflamed pleural or pericardial surfaces on one another.
• Occur in:
1- Pleurisy . 2- Pericarditis.
• Aggravating and relieving factors:
- Not brought on by exertion but relieved by:
1- Sitting up.
2- Leaning forward.

Subtopic

• Localised to small area.
• Sharp associated with respiration or movement of shoulders rather than exertion.
• Last for few seconds or to long periods.

• Retrosternal.
• Come after eating or drinking.
• Associated with Dysphagia.
• Relieved by nitrate.

• Sharp pain.
• Localized to one part of the chest.
• Associated with severe dyspnea.