【Health Lecture】About chest pain: pleurisy

The first rays of sunlight in the morning shone into the outpatient clinic of the geriatric department. At this time, a young patient, Ms. Hu, 38 years old, walked into the clinic with a hunched back and said to me in a hurried tone: "Doctor, I am a desk worker and have always had back pain. Doing yoga can relieve it. After get off work yesterday, I felt a little pain in my left chest and back. I didn't take it seriously. As a result, it hurt when I turned over at night. I must have stretched it carelessly. Please prescribe me some painkillers and ointments quickly. I am in a hurry to go to work." Looking at the patient's painful expression, a bunch of suspicious diagnoses quickly appeared in my mind: pneumothorax? Aortic dissection? Myocardial infarction? Pulmonary embolism? ... After my repeated persuasion, the patient agreed to do a chest CT, electrocardiogram, and laboratory tests. After the CT, the patient came to me and said: "Doctor, I feel pain every time I breathe, and the pain is getting worse. What's wrong with me?" So what disease did Ms. Hu have? As the patient's lung CT and test results came out, the mystery was gradually solved: one of the main culprits of chest pain that we are going to talk about today - pleurisy.

So what is pleurisy? Pleurisy, a term that sounds a little unfamiliar, is actually a common chest disease. It refers to inflammation that occurs in the pleural cavity. The pleura is a serous membrane covering the inner surface of the chest wall and the surface of the lungs. It is divided into two parts, the parietal layer and the visceral layer. The enclosed space between the two layers is called the pleural cavity. Pleurisy may be caused by a variety of reasons, which not only affects our respiratory function, but may also cause a series of physical discomfort. Therefore, understanding the relevant knowledge of pleurisy is crucial to maintaining our physical health. Pleuritic chest pain is a sharp, stabbing pain that worsens when inhaling, and is more severe when taking a deep breath, laughing or coughing. It is often caused by pleural lesions. So what are the causes of pleurisy?

The occurrence of pleurisy is often closely related to our living habits, environment and body immune status. In general, the first two of the following reasons are clinically called pleurisy, that is, inflammation of the pleural cavity caused by infectious factors. The last four are called pleural effusion. 1. Lung infection is one of the common causes of pleurisy. When we suffer from lung diseases such as pneumonia and bronchitis, inflammation may spread to the pleura, causing pleurisy. When there are signs of infection such as fever, cough, and sputum, we should be alert to bacteria, viruses, fungi, parasites, etc. that cause lung infections and then cause pleurisy. 2. Mycobacterium tuberculosis infection: The estimated number of tuberculosis patients in my country is 748,000, ranking third in the world. The population is generally susceptible. In addition to chest pain, it may also be accompanied by fever, fatigue, night sweats and other symptoms of tuberculosis poisoning. Since tuberculous pleurisy is contagious, patients need to seek medical treatment in time and receive isolation treatment. 3. Tumors: Pleural metastatic tumors: such as lung cancer, breast cancer, lymphoma, myeloma, ovarian cancer, pancreatic cancer, bile duct cancer, etc. can cause pleural effusion. It can also cause chest pain, dyspnea and other symptoms. 4. Pulmonary embolism: When there are factors such as lower limb fractures, tumors and other hypercoagulable factors, chest tightness, chest pain, dyspnea, and unexplained pleural effusion, pulmonary embolism should be considered. 5. Autoimmune diseases: such as systemic lupus erythematosus, granulomatosis with polyangiitis (Wegener's disease), rheumatoid arthritis and Langerhans cell histiocytosis can also cause pleural effusion. It can cause clinical symptoms such as chest pain and breathlessness. 6. Drug-induced: Currently, the drugs that have been confirmed to induce pleural inflammation and pleural effusion include nitrofurantoin, dantrolene, methysergide, amiodarone, interleukin-2, procarbazine, methotrexate, clozapine, phenytoin and beta-receptor blockers: we often say Betaloc, etc. Clinical manifestations of pleurisy

The clinical manifestations of pleurisy are varied. The most common symptoms include chest pain, chest tightness, cough and dyspnea. Chest pain usually manifests as stabbing or pulling pain, and the pain may worsen when taking a deep breath or coughing. Chest tightness is because the inflammation causes the pressure in the pleural cavity to increase, making breathing difficult. Coughing is one of the common symptoms of patients with pleurisy, mainly to discharge the effusion or inflammatory secretions in the pleural cavity. As the disease progresses, the symptoms of pleurisy may gradually worsen. If not treated promptly and effectively, the inflammation may spread to surrounding tissues or organs, leading to more serious consequences. For example, purulent pleurisy may lead to the formation of empyema or parapneumonic effusion, which may even be life-threatening in severe cases. Treatment of pleurisy

Pleurisy is painful, especially when inhaling, which restricts the patient's breathing. In this case, analgesics such as ibuprofen and loxoprofen are usually used. When the pain cannot be relieved, strong analgesics such as tramadol or hydroxycodone can be used.

Of course, the most important thing is to eliminate the cause: the most important cause of pleurisy is infection: for example, when pneumonia is caused by bacteria and empyema, appropriate antibiotics can be selected according to the results of microbial culture. If the empyema is severe, a chest drainage tube is usually used to drain the pus. When it is caused by a viral infection, it will generally disappear on its own after a few days or weeks, and appropriate symptomatic analgesic treatment can be used.

When chest pain is accompanied by shortness of breath and decreased peripheral finger pulse oxygen, one should be alert to the possibility of pulmonary embolism, which may require thrombolysis, anticoagulation and other treatments.

For drug-induced pleurisy, the drug should be discontinued or replaced promptly, and other possible causes of pleurisy should be further investigated.

When cancer patients experience symptoms such as chest pain, they need to be alert to pleural metastasis. On the basis of treating the primary disease, symptomatic treatments such as analgesia and relief of wheezing become particularly important, and the patient's emotions need to be actively soothed.

So how do we prevent pleurisy?

Enhance immunity: Eat a healthy diet, have a regular work and rest schedule, avoid staying up late, and exercise moderately: including aerobic exercise and moderate resistance training. Avoid infection: Pay attention to personal hygiene: Wash hands frequently with soap, avoid contact with infectious sources, and all patients with autoimmune diseases such as rheumatoid arthritis who are aged ≥ 65 years need to be vaccinated with pneumococcal polysaccharide vaccine (PPSV). Patients with chronic lung disease or chronic immunosuppression need to be vaccinated with PPSV and pneumococcal conjugate vaccine. Reduce the use of glucocorticoids according to the condition, which may also reduce the incidence and severity of lower respiratory tract infections.

Wet your hands with clean water and apply a small amount of soap. Rub your hands together to create a foam and rub for at least 20 seconds. Clean your wrists, palms, backs of hands, between fingers, fingertips, thumbs, and under and around nails. Rinse well and dry your hands with a clean towel. Treat the primary disease early: control lung infections, tumors, autoimmune diseases, etc. Regular physical examinations: detect potential causes early and prevent pleurisy. In short, when you have chest pain, don't be careless. Please actively seek medical attention to check for related factors. Of course, there is no need to panic. As long as you have a balanced diet, a healthy work and rest schedule, proper physical exercise, and strengthen your body, the disease will retreat. Picture: Qianku.com

About the Author:

Liu Xinxin, attending physician of the Department of Geriatrics, Beijing Longfu Hospital, has studied in the General Hospital of Aerospace and Union Hospital. He is good at the diagnosis and treatment of common diseases such as acute cerebrovascular disease, hypertension, hyperlipidemia, coronary heart disease in the elderly, as well as difficult and critical diseases in the elderly.