Chest pain medical therapy

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Chest pain Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chest pain from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Chest Pain in Pregnancy

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

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Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

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Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

A correct diagnosis of the underlying cause of the chest pain is necessrary prior to deciding on an appropriate treatment strategy. The most dangerous causes should be evaluated first. If myocardial infarction or ischemia is suspected, the immediate pharmacotherapies including morphine, oxygen, nitrate, aspirin, ACE inhibitors.

Medical Therapy

General Strategies for the Management of Acute Chest Pain

  • Obtaining a thorough patient history is often the most valuable tool in coming to a diagnosis. In angina pectoris, for example, blood tests and other analyses are not sufficient to make a diagnosis (Chun & McGee 2004).
  • The physician's typical approach is to rule out the most dangerous causes of chest pain first (e.g., myocardial infarction, pulmonary embolism). By sequential elimination or confirmation from the most serious to the least serious cases, a diagnosis of the origin of the pain is eventually made. Emergency reperfusion therapy either by percutaneous coronary intervention or thrombolytic agents is recommended after diagnosis.
  • Often, no definite cause will be found, and the focus in these cases is on excluding severe conditions and reassuring the patient

Immediate Management

Acute coronary syndrome

Pulmomary embolism

Pneumothorax

  • Chest pain due to pneumothorax required immediate decompression with a chest tube.

Cardiac tamponade

  • Suspected cardiac tamponade is diagnosed via bedside ultrasound. A pericardial window or needle pericardiotomy is therapeutic.

Aortic dissection

  • Aortic dissection is almost always a surgical emergency[2].
  • The best test for diagnosis is CT angiography[3].

Gastresophageal reflux disease

  • It is important to differentiate between acute coronary syndrome and GERD in a patient presenting with burning chest pain.
  • Proton pump inhibitors and H2 blockers are the first-line recommended treatments for GERD[4].

References

  1. Johnson K, Ghassemzadeh S. PMID 29262011. Missing or empty |title= (help)
  2. Zhao DL, Liu XD, Zhao CL, Zhou HT, Wang GK, Liang HW, Zhang JL (October 2017). "Multislice spiral CT angiography for evaluation of acute aortic syndrome". Echocardiography. 34 (10): 1495–1499. doi:10.1111/echo.13663. PMID 28833419.
  3. Shiber JR, Fontane E, Ra JH, Kerwin AJ (June 2017). "Hydropneumothorax Due to Esophageal Rupture". J Emerg Med. 52 (6): 856–858. doi:10.1016/j.jemermed.2017.02.006. PMID 28336238.
  4. Alzubaidi M, Gabbard S (October 2015). "GERD: Diagnosing and treating the burn". Cleve Clin J Med. 82 (10): 685–92. doi:10.3949/ccjm.82a.14138. PMID 26469826.