Сhest pain: a modern review of pain medicine
Keywords:chest pain, thoracalgia, cardialgia
Abstract. Background. Approximately 1% of all reasons for visits to primary care physicians are chest pain, and in 2–4% of these patients pain is the cause of potentially life-threatening cardiovascular disease. For a correct and quick diagnosis, it is extremely important that the clinician and the patient speak “one language”: the described complaints should be interpreted quickly and correctly, and the doctor’s questions should be clear to the patient. It is very important to get information from the patient about any accompanying symptoms and a detailed description of chest discomfort. History taking and physical examination should take the minimum amount of time required. That is why it is necessary to understand how and why conditions develop, the manifestation of which is pain in the chest. To highlight the significant variability of clinical manifestations of thoracalgia, mechanisms of development and features of clinical and laboratory-instrumental diagnosis of the causes of chest pain is a main aim of the review. Materials and methods. Modern foreign guidelines for the management of patients with chest pain, written in English, were used.
Conclusions. After injuries, chest pain is the main reason of patients visits to the admission department for urgency care. Longstanding classification of the chest pain causes divides it into cardiac and non-cardiac, and cardialgia, in turn, can be subdivided to pain, caused by ischemic changes in the myocardium, and the one with a non-ischemic origin. Patients often do not use the term “pain” to describe their symptoms, but often use other terms such as discomfort, compression, or may associate discomfort with indigestion. When chest pain is caused by ischemia or insufficient coronary blood flow, it is called ischemic thoracalgia. Detection of angina pectoris is one of the main problems in the examination of patients with chest pain, and thoracalgia, which clinically and instrumentally correlates with acute angina pectoris, requires urgent diagnosis and treatment, as it may be a sign of acute coronary syndrome (ACS). Thoracic pain can not only affect the heart muscle, but also radiate from other anatomical areas or be felt secondarily, if it develops in an adjacent anatomical area (eg, thoracic spine, epigastric pain, etc.). Both acute and chronic chest pain should be carefully evaluated by a clinician, and further examination may be performed based on his findings. Appropriate and necessary laboratory and instrumental examination of patients, taking into account all possible risks, not only allows to quickly establish an accurate diagnosis, but also leads to more effective treatment.
Lamont JT. Evaluation of the adult with chest pain of esophageal origin.
Haber MD M. Angina Pectoris in Emergency Medicine.
SCHOENKERMAN AB, GOLDSCHLAGER N. Chest Pain: Does This Patient Have Cardiac Ischemia?. Consultant. 2017 Feb 16.
Takotsubo cardiomyopathy (broken-heart syndrome) [Internet]. Harvard Medical School. 2020 Jan.
Schultheiss H-P, Fairweather D, Caforio ALP, Escher F, Hershberger RE, Lipshultz SE, et al. Dilated cardiomyopathy. Nature Reviews Disease Primers [Internet]. Springer Science and Business Media LLC; 2019 May 9;5(1). Available from: https://doi.org/10.1038/s41572-019-0084-1
Al-Akchar M, Kiel J. Acute myocarditis. InStatPearls [Internet] 2021 May 12. StatPearls Publishing.
Zareifopoulos N. Is there such as a thing as non-ischaemic cardiac pain?. Heart Asia. 2016 Jul 1;8(2):54-5. Available from: https://doi.org/10.1136/heartasia-2016-010820
Gutersohn A, Zimmermann U, Bartel T, Erbel R. A rare case of acute'infective'myocardial infarction triggered by acute parvovirus B19 myocarditis. Nature Clinical Practice Cardiovascular Medicine. 2005 Mar;2(3):167-71. Available from: https://doi.org/10.1038/ncpcardio0126
Eric B, Tomich DO. Takotsubo (Stress) Cardiomyopathy (Broken Heart Syndrome). [Internet]. Medscape. 2019 Jul.
Spangler S. Acute pericarditis. [Internet]. Medscape. 2019 Apr.
Ziccardi MR, Hatcher JD. Prinzmetal Angina. InStatPearls [Internet] 2020 Aug 16. StatPearls Publishing.
Chaudhary I. Microvascular angina: Angina pectoris with normal coronary arteries. InUpToDate 2018.
Agrawal S, Mehta PK, Bairey Merz CN. Cardiac Syndrome X. Cardiology Clinics [Internet]. Elsevier BV; 2014 Aug;32(3):463–78. Available from: https://doi.org/10.1016/j.ccl.2014.04.006
Chiabrando JG, Bonaventura A, Vecchié A, Wohlford GF, Mauro AG, Jordan JH, Grizzard JD, Montecucco F, Berrocal DH, Brucato A, Imazio M. Management of acute and recurrent pericarditis: JACC state-of-the-art review. Journal of the American College of Cardiology. 2020 Jan 7;75(1):76-92. Available from: https://doi.org/10.1016/j.jacc.2019.11.021
Masek KP, Levis JT. ECG diagnosis: acute pericarditis. The Permanente Journal. 2013;17(4):e146. Available from: https://doi.org/10.7812/TPP/13-044
Akbar H, Foth C, Kahloon RA, Mountfort S. Acute ST elevation myocardial infarction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532281/
Wilkins TG. Echo for the Assessment of Acute Chest Pain [Internet].
Schiller NB, Ren X, Ristow B. Echocardiographic recognition of cardiomyopathies. UpToDate [Internet]. 2022 Feb 21.
Mancini MC, Geibel J. Aortic dissection. URL: http://emedicine.medscape.com/article/2062452-overview. Updated: Jan. 2019;8.
Fass R, Achem SR. Noncardiac Chest Pain: Epidemiology, Natural Course and Pathogenesis. Journal of Neurogastroenterology and Motility [Internet]. The Korean Society of Neurogastroenterology and Motility; 2011 Apr 30;17(2):110–23. Available from: https://doi.org/10.5056/jnm.2011.17.2.110
Patti MG. Gastroesophageal Reflux Disease Clinical Presentation. Medscape [Internet]. 2021 Oct.
Cai JX, Achem SR. Non – cardiac Chest Pain American College of Gastroenterology [Internet]. 2021 June.
Fazekas D, Doroshenko M, Horn DB. Intercostal Neuralgia. InStatPearls [Internet] 2021 Aug 16. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560865/
Confer J, Egbert-Kibler J. Pleurisy: Symptom or Condition? Medscape [Internet]. 2022 May.
Daley BJ. Pneumothorax. Medscape [Internet]. 2020 Apr.
Rare Disease Database Tietze Syndrome. NORD [Internet].
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This work is licensed under a Creative Commons Attribution 4.0 International License