Good history taking is particularly important in the evalualion of chest pain. It is a cardinal sign ofcardiac distress, listen to its voice.
Angina pectoris is retrosternal in position and the pain, pressure or discomfort may radiate to the left or right arm, epigastrium, either shoulder, neck or the jaw. Samuel Levine often remarked that the patient describes anginal pain by placing his closed fist on the sternum (Levine sign). The duration of the pain is less than 2-1 0 min and it is usually precipitated by exertion, emotional stress, a heavy meal, cold weather, walking up a slope or a hilly area or by a sudden rise in blood pressure. Anginal pain is relived by rest or sublingual nitroglycerine. Mandibular or jaw paill though rare can be misleading as jaw pain might suggest a dental problem. During angina, the BP may shoot up and a systolic murmur of papillary inuscle dysfullction inay be heard at tlie apex or right lower sternal region of the heart.
The variant form, Prinzmetal's angina is unrelated to activity and may occur at a fixed time, often early in the morning (vasospastic angina).Angina at rest resembles effort angina in character but the syinptoins may be pronounced and signs of heart failure rnay be present.
The first attack of angina or changes in severity orailgina with varying symptonls occurring in quick succession is called unstable angina. It nlay have a crescendo character.Clinical Evaluation
Classification of Angina
There are many classifications of the Angina Pectoris but Canadian Cardiovascular Societies calssification is widely accepted.
Myocardial Infarction
Myocardial Infarction The location and radiation of the pain is as in angina but the duration is inore than 20 minutes. The pain is unrelieved by rest or nitroglycerine. 11 nlay ~natlifest with a sense of oppressioll or a knife-like thrust sensation, shortness of breath, swealitlg, weakness and sometilnes nausea and vomiting may accoinpany the pain. The heart rate is usually raised. It is worthy of note that myocarclial i~lfarction may be silent episode in diabetics.
Angina pectoris is retrosternal in position and the pain, pressure or discomfort may radiate to the left or right arm, epigastrium, either shoulder, neck or the jaw. Samuel Levine often remarked that the patient describes anginal pain by placing his closed fist on the sternum (Levine sign). The duration of the pain is less than 2-1 0 min and it is usually precipitated by exertion, emotional stress, a heavy meal, cold weather, walking up a slope or a hilly area or by a sudden rise in blood pressure. Anginal pain is relived by rest or sublingual nitroglycerine. Mandibular or jaw paill though rare can be misleading as jaw pain might suggest a dental problem. During angina, the BP may shoot up and a systolic murmur of papillary inuscle dysfullction inay be heard at tlie apex or right lower sternal region of the heart.
The variant form, Prinzmetal's angina is unrelated to activity and may occur at a fixed time, often early in the morning (vasospastic angina).Angina at rest resembles effort angina in character but the syinptoins may be pronounced and signs of heart failure rnay be present.
The first attack of angina or changes in severity orailgina with varying symptonls occurring in quick succession is called unstable angina. It nlay have a crescendo character.Clinical Evaluation
Classification of Angina
There are many classifications of the Angina Pectoris but Canadian Cardiovascular Societies calssification is widely accepted.
Myocardial Infarction
Myocardial Infarction The location and radiation of the pain is as in angina but the duration is inore than 20 minutes. The pain is unrelieved by rest or nitroglycerine. 11 nlay ~natlifest with a sense of oppressioll or a knife-like thrust sensation, shortness of breath, swealitlg, weakness and sometilnes nausea and vomiting may accoinpany the pain. The heart rate is usually raised. It is worthy of note that myocarclial i~lfarction may be silent episode in diabetics.
Conditions Mimicking Anginal Pain or Myocardial Infarction
These include pericarditis where the pain lasts Tor a long period and is aggravated by deep breathing and the supine position. It is relieved on sitting up and leaning forward. Aortic dissection is accoinpailied by a 'tearing' pain of sudden origin radiating backward. Pulmona~y einbolisim gives a sharp pain (pleuritic in type) and Pullnonary hypertension produces a heavy pressure like pain.
A pricking chest pain is seen in initral valve prolapse (MVP). This type of pain imay bc accompanied by costo-chondral pain in the third left intercostal space (Tietze's syndrome). Post operatively, pleuro-pericardial pain inay be present due to pericarditis (Dressler'ssyndmme).
Peptic ulceration in the esophagus or stomacli quite often mimics angina. Many elderly patients have a hiatus hernia with reflux esophagitis-this too may mimic coronary pain.Local pain over the nipple can be due to spironolactone therapy. Look for gynecomastia. Before herpes zoster appears there can be excruciating intercostal pain.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.