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To determine the cause of chest pain there is to know if its start is very intense and sudden, and in this case would associate with the presence of aortic dissection, pneumothorax, or pulmonary embolism. Or, on contrary, if this is gradual, it is described as a discomfort, oppression, which gets worse with stress/effort, it is more suggestive of an acute coronary syndrome.
In the evaluation of chest pain, the presence of associated symptoms also has to be considered:
Aortic dissection. There can be multiple, associated symptoms depending on the part of the aorta affected, and the extent of the dissection, including: loss of consciousness, neurological symptoms (loss of movement in one part of the body or one half of the body, change in mental state).
Pulmonary embolism. Although the most common accompanying symptom is shortness of breath (dyspnoea), it can also be presented with loss of consciousness, cough, sputum with blood (haemoptysis), a slight fever, and very often is preceded by pain and swelling in one leg (it suggests a thrombosis at this level).
Pneumothorax or pneumonia, pericardial or pleural effusion. Shortness of breath is usually the predominant symptom.
Gastrointestinal causes. Nausea and belching are normally indicative of gastrointestinal causes, although it should not be forgotten that nausea may also be present in acute coronary syndrome.
The alarm symptoms in a patient with chest pain are: intense pain or discomfort, radiating to the neck, arms, jaw, or back, accompanied by sweating, nausea, shortness of breath, and loss of consciousness.
Description of the chest pain
Acute pain described as the feeling as if you have been stabbed with a knife, or which changes with position is much less likely to be caused by an acute coronary syndrome.
Acute coronary syndrome. The pain is more described as a discomfort, pressure, heaviness, or a bloated feeling, than as pain. It is normally located on the left or centre of the chest and can extend (radiate) to the arm, neck, jaw, or back, but it is occasionally difficult to pinpoint its location. It can start at rest, after an effort, or after a situation of stress. If the pain also increases with effort, it significantly increases the likelihood that it is an acute coronary syndrome. It should be remembered that if you are of advanced age, a diabetic, or a woman, it may not have such a typical clinical presentation, and may start with less specific symptoms, such as weakness or a feeling of breathlessness.
Aortic dissection. The pain is usually very intense, wrenching, normally located in the front part of the chest, but can also start in the back and extend towards the abdomen, depending on which part of the aortic artery is affected and the extent of the dissection.
Pulmonary embolism. The pain is also acute, but does not have a typical characteristic that defines it. It usually gets worse with deep breathing and is accompanied by shortness of breath. However, it may also be presented as just shortness of breath with no chest pain.
Pneumothorax. The pain is centred in the affected lung, is usually acute, dull.
Pericarditis. The pain is very positional, in general it gets worse on lying down and improves on sitting up and leaning forward. It also gets worse with deep breathing. The acute, very easy to locate, chest pain, which is triggered or increased with palpation of the chest wall or with movement is very characteristic of musculoskeletal pain causes.
The pain described as burning or heartburn in the chest or the area of the stomach is usually more characteristic of gastrointestinal causes.
How long does chest pain last?
The chest pain in the case of angina last a few minutes, and in an infarction, it is much longer. It calms down or gets better with rest or after the administration of nitrates.
On the other hand, non-coronary pain is often of short duration. It is described as stabbing, intense and easy to locate with just one finger (particularly that of submammary). It can change with breathing.