Chest
A. Sahib El-Radhi in Paediatric Symptom and Sign Sorter, 2019
Chest pain is a common complaint in children. It is the second most frequent cause of referral to paediatric cardiologists after cardiac murmur. Although chest pain in adults is considered a medical emergency because of possible associated heart attack, the overwhelming majority of children have a non-cardiac aetiology. The most common causes of chest pain include idiopathic, injury, musculoskeletal myalgia, pulmonary diseases (e.g. asthma), cardiac, gastrointestinal disorders and psychogenic causes. Many teenagers present with psychogenic chest pain, often with hyperventilation, reflecting anxiety generated by some events. Other teenagers have chest pain because of benign transient intercostal muscle spasm. Chest pain can be acute or chronic, which lasts by definition longer than 6 months. Although chronic or recurrent chest pain is likely to be benign (mostly caused by anxiety), this complaint often leads to numerous school absences, restriction of normal activities and considerable worry for patients and their parents.
What Is Diagnosis?
Pat Croskerry, Karen S. Cosby, Mark L. Graber, Hardeep Singh in Diagnosis, 2017
First-line physicians do not always make a formal diagnosis for all complaints. A patient who presents with chest pain will typically have a clinical evaluation (history and physical examination) and basic tests (electrocardiogram, chest x-ray, troponin, d-dimer). Absent any clear explanation, they may be offered a diagnosis of exclusion, such as nonspecific chest pain, implying a condition likely of no consequence. No true diagnosis may be reached. Both provider and patient may be satisfied to accept the absence of significant disease as an end point itself without reaching a specific diagnosis or explanation for their symptoms. In fact, the willingness to avoid a premature label for a clinical syndrome is desirable, since an inaccurate label may mislead both the patient and other clinicians at future encounters. In cases where there is no clearly established diagnosis, a label of “not yet diagnosed” (NYD) may serve as a marker of need for future testing should the condition persist or worsen.
Esophageal Disorders and Their Relationship to Psychiatric Disease
Kevin W. Olden in Handbook of Functional Gastrointestinal Disorders, 2020
The third treatment approach for chest pain involves the use of psychotropic medications. Gupta and colleagues (100) recently reported that imipramine significantly reduces the frequency of chest pain episodes relative to placebo and clonidine. It has been shown that other tricyclic medications have analgesic effects, although none of these medications has been tested in controlled trials in patients with CPUE (41). Similarly, none of the selective serotonin reuptake inhibitors has been evaluated for use with these patients. A small uncontrolled study has shown that patients with CPUE and panic disorder respond well to alprazolam (101). It should be noted, however, that alprazolam and other benzodiazepines are most appropriate for short-term use since patients have difficulty in discontinuing these medications (102). Thus, we tend to prescribe alprazolam for appropriate patients using 6-month trial periods and planned withdrawal schedules to minimize drug dependency. Alternatively, we will use buspirone; this medication has not been subjected to clinical trials with CPUE patients, but it frequently is helpful to patients and it may be discontinued without adverse side effects.
AMI in (bi)ventricular pacing – do not discard the ECG
Published in Acta Clinica Belgica, 2023
T. Versyck, D. Devriese, S. Smith, P. Calle, C. Borin
Chest pain is one of the most common symptoms among patients in the emergency department. The diagnosis of AMI relies initially on the patient’s medical history and risk factors, the anamnesis and the 12-lead ECG. However, in the presence of a pacemaker rhythm, the electrocardiographic diagnosis becomes difficult, but not impossible. There is a growing body of literature that suggests that Smith-modified Sgarbossa criteria can be applied for the diagnosis of STEMI in patients with paced rhythms. The Sgarbossa criteria were originally developed for the interpretation of ECGs in chest pain patients with a LBBB, but have been expanded to paced ECGs and optimized by Smith to increase sensitivity and specificity (Figure 1). We present three cases of chest pain patients with, respectively, right ventricular and biventricular pacing and delayed STEMI diagnosis.
Current evidence of COVID-19 vaccination-related cardiovascular events
Published in Postgraduate Medicine, 2023
Sajad Khiali, Afra Rezagholizadeh, Hossein Behzad, Hossein Bannazadeh Baghi, Taher Entezari-Maleki
Regarding male predominance in the development of myocarditis and pericarditis, a highly possible explanation relates to different main sex hormones and their effects on the heart and immune system; however, underdiagnosed heart conditions could be another reason for this rate difference [20]. The occurrence of myocarditis mainly following the second dose of vaccines could be due to a hypersensitivity phenomenon after receipt of the first dose as a sensitizing dose [20,34].Evidence shows that myocarditis/pericarditis symptoms following COVID-19 mRNA vaccine administration usually begin during seven days of vaccination ranging from 6 hours to several days in some case reports [22,34,35]. The predominant symptoms are chest pain which may be respiratory‐dependent, dyspnea, palpitation, chest discomfort, myalgia, sub-febrile to febrile temperatures, and fatigue. Clinically significant signs of COVID-19 vaccine-related myocarditis included elevated troponins (peak between 48–72 h after symptom onset), C-reactive protein elevation, minor pericardial effusion, and nonspecific electrocardiographic changes, such as mild diffuse ST-segment changes, PQ segment depressions, sinus tachycardia, and rarely supraventricular or ventricular arrhythmias. Cardiac troponin values were elevated up to 400 times higher than the normal level in myocarditis cases. On the contrary, pericarditis cases usually show normal cardiac troponin levels [20,35–42].
The predictive role of modified TIMI risk index in patients with ST-segment elevation myocardial infarction
Published in Acta Cardiologica, 2019
Adnan Kaya, Muhammed Keskin, Tolga Sinan Güvenç, Mustafa Adem Tatlısu, Osman Kayapınar
Between July 2009 and July 2012, 5429 consecutive confirmed STEMI patients who were admitted to emergency department of a tertiary heart centre were evaluated retrospectively. The patients were evaluated in a high-volume tertiary heart centre [> 2500 percutaneous coronary intervention (PCI) per year] and the study was approved by the institutional review board. Because of the retrospective nature of the study, written informed consents from the patients were not obtained; however, we excluded the patients refused to participate in the study during follow-up. All patients diagnosed with STEMI according to the following criteria were included in the study: (a) typical chest pain lasting for more than 30 min and (b) ST-segment elevation in at least two contagious leads with the following cut-off points: at least 0.2 mV in men or at least 0.15 mV in women in leads V2–V3 and/or at least 0.1 mV in the other leads or definite/probable a new left bundle branch block [2]. All electrocardiograms were retrieved from patients’ files or from hospital’s electronic database to confirm if the aforementioned criteria were fulfilled. Patients whose electrocardiograms could not be retrieved and/or whose data to calculate TRI and mTRI were missing were excluded from the study.
Related Knowledge Centers
- Acute Coronary Syndrome
- Angina
- Diabetes
- Epigastrium
- Myocardial Infarction
- Shortness of Breath
- Thorax
- Nausea
- Heart
- Pain
- Shortness of Breath