Chest pain is a Common complaint in emergency department (ED). Approximately 5% of all ED visits or 5 million visits per year is due to chest pain .There is a wide range of etiologies Cardiac, Pulmonary, Gastrointestinal, Musculoskeletal. Distinguishing these causes matter because management vary according to etiology.
When there is a block in coronary arteries that supply heart muscle it will produce heart attack .Most common manifestation is cardiac pain which is called angina pectoris.
Key features of typical cardiac pain
From history
Location : Pain can be central, left or right part of chest.
Timing : It can be gradual or sudden onset.
Provocation : By exertion.
Quality : Diffuse or constricting type of pain it can be an uncomfortable pressure, fullness, squeezing in the chest.
Radiation : Can radiate to back, neck and arm.
Severity : Severity vary from a scale of 1-10.
Associated symptoms : Breathlessness, sweating, nausea, fainting, feeling of impending doom, cold clammy skin may be present.
When the patient is asked to localize the sensation, he or she will typically press on the sternum, sometimes with a clenched fist, to indicate a squeezing, central, substernal discomfort (Levine's sign).
Levine's sign
Key Emergency Physical examination
- General appearance - Patients are usually anxious and restless.
- Vital signs - Watch for hypotension or hypertension.
- Heart - Examine the heart sounds is it muffled? regular? fast?
- Neck dilated neck vein.
- Abdominal distension.
- Lowerlimb oedema and calf muscle tenderness.
- All these features need not be present in every patients.
Whenever you have chest pain consider above mentioned points you should not ignore the chest pain if at least one or two features are present and attend the emergency department and do proper evaluation.Early diagnosis is important because if there is a delay in treatment more than 6 hours, there will be irreversible damage to heart muscles.
