The cardiovascular diseases

PAIN IN THE CHEST (THORACIC PAIN)

- What is the right behaviour in case of pain in the chest?
- The Causes of pains in the chest :

1. Thoracic pain of cardiovascular origin
2. Thoracic pain of pleuropulmonary origin
3. Thoracic pain of digestive origin
4. Thoracic pain coming from the thoracic wall
5. Thoracic pain of neurological origin
6. Thoracic pain and anxiety

The physician should otherwise search for a cardiovascular cause in priority, whose main illnesses are the angina pectoris, the myocardial infarction, the dissection of the aorta and the pulmonary embolism.

Any occurrence of a pain in the chest must lead you to consult your physician.

WHAT IS THE RIGHT BEHAVIOUR IN CASE OF PAIN IN THE CHEST?

You must consult your physician as quickly as possible, who will achieve:

1 - A questioning:

It should separate the acute pains from the chronic pains: the first ones must be treated in emergency; the other ones permit the implementation of a few simple complementary exams.

With the clinical exam, the questioning orients the check-up:

- Case and family history, cardiovascular risk factors (cigarettes smoking, cholesterol, obesity, diabetes, hypertension) and previous history of phlebitis, current treatment...

- The characteristics of the pain must be specified while avoiding being too suggestive: type, site, irradiation, date of occurrence, duration, repetition, occurrence or triggering circumstances, calming factors.

- The associated signs as fever, shortening of breath, cough, sweats, paleness and losses of consciousness, palpitations...

2 - The clinical exam by the physician:

First, he searches for the factors of seriousness imposing an urgent treatment: signs of heart failure or respiratory insufficiency, rise of HBP or on the contrary considerable hypotension.

The rest of the exam focuses on the cardiovascular and pulmonary systems looking for:

- A cardiac murmur, a friction rub of the pericardium,

- A palpation/auscultation of all arterial courses;

- An exam of the veins of the lower limbs;

- An exam of the thoracic wall and the spine;

- A pulmonary percussion/auscultation

- A taking of the B.P. on the 2 arms.

3 - The first exams asked by the physician are:

A blood test, a lung x-ray, an electrocardiogram, an arterial gasometry (blood test at the level of the wrist artery).

At the end of this check-up, the diagnosis is usually made or is sufficiently suspected to ask for the exams, which will make the diagnosis.

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File last reviewed on dec 18, 2011