Is chest pain angina?

This is the 4995th article of Da Yi Xiao Hu

Today an elderly man came to see a doctor and said he had obvious pain in the precordial area, as well as pain in the back and entire arm. The pain was paroxysmal and had lasted for more than a week. He was very worried that it might be angina pectoris.

What is angina pectoris (taking stable exertional angina pectoris as an example)? It is characterized by sudden occurrence during activities or emotional excitement, and the compression, stuffiness or suffocation pain behind the sternum may spread to the entire left chest and radiate to the left shoulder and left upper arm, and sometimes to the mandible, pharynx, etc. Severe pain may cause sweating, and patients often have to stop activities immediately. Deep breathing does not help improve symptoms. Sublingual nitroglycerin or resting for a few minutes (generally no more than 5 minutes) can relieve the symptoms. This is a signal of insufficient blood supply to the coronary arteries, indicating that there is obvious stenosis or even blockage of the coronary arteries. Patients need to pay great attention and seek medical treatment in time, otherwise the disease is likely to progress and there is a high risk of fatal diseases such as acute myocardial infarction.

Other causes of chest pain include chest wall lesions, lung and pleural lesions, cardiovascular system diseases, mediastinal and esophageal lesions, anxiety, etc.

1. Chest wall lesions

In daily life, pain caused by the chest wall is relatively common. It is related to local skin, muscle, and bone lesions caused by chest wall trauma or bacterial infection, viral infection, tumor, etc. Common ones include acute dermatitis, herpes zoster, cervical spondylosis, etc. They all have a common feature. Generally, the pain is fixed at the site of the lesion, and there is obvious tenderness locally. In addition, the pain of chest movement will be aggravated when taking deep breaths, coughing, bending over, etc. For example, in the most common chest trauma, the chest pain will become severe after a few days, and will slowly ease after 2 to 3 weeks.

2. Lung and pleural lesions

This phenomenon is not sensitive to pain. Pneumonia, tuberculosis, etc., will only cause pain when they damage the wall layer. Generally, spontaneous pneumothorax will cause sudden severe pain due to adhesion tearing, and dry pleurisy will cause pain due to friction caused by inflammation and flatulence. What they have in common is that they usually have coughs or sputum, which become serious because of these symptoms. Other chest wall activities will not cause pain, and there is no local tenderness.

3. Cardiovascular system diseases

This phenomenon is more common in angina pectoris, myocardial infarction and pericarditis. Their common characteristics are that the main pain is located behind the sternum or in the precordial area, and in a few cases under the xiphoid process, and can radiate to the left shoulder.

4. Mediastinal and esophageal lesions

This phenomenon is relatively rare, and chest pain is caused by diseases such as acute mediastinitis and mediastinal tumors. Esophageal diseases are caused by the esophageal mucosa. Their common characteristics are that chest pain is generally located behind the sternum and is persistent, dull or distending, and usually radiates to other parts.

5. Anxiety

This phenomenon is more common in middle-aged men and menopausal women, and is usually caused by family pressure.

How can we detect and treat dangerous chest pain?

1. The location and nature of chest pain in acute myocardial infarction are similar to angina pectoris, but it lasts for a long time and cannot be relieved by rest or taking nitroglycerin. At this time, the patient should call an ambulance immediately and be sent to a hospital with myocardial infarction treatment qualifications by professional rescue personnel, and receive coronary intervention in time to save his life.

2. Acute aortic dissection is also one of the fatal cardiovascular diseases. Its typical characteristics are sudden tearing or knife-like pain in the chest and back. The pain is extremely severe and unbearable. The patient may faint and go into shock. At this time, the patient should immediately stop all physical activities, call an ambulance, and be sent to the hospital for emergency treatment by professional rescue personnel.

3. The pain caused by acute pericarditis is mainly located in the middle left of the chest, with a continuous pain like a knife, and can also be manifested as a sense of oppression and dull pain; the pain may be aggravated by deep breathing, coughing, and lying; the pain may be slightly relieved when sitting forward. Patients are often accompanied by fever. Those who suspect pericarditis should seek medical attention in time, find out the cause and receive targeted treatment.

After completing various examinations, the elderly man was found to have no cardiovascular disease. After a detailed interview and physical examination, it was found that the patient had multiple scattered herpes on his left index finger and arm. After consultation with the dermatologist, he was diagnosed with herpes zoster and received active symptomatic supportive treatment.

Author: Department of Geriatric Cardiology, Zhongshan Hospital, Fudan University

Shen Jun, deputy chief nurse

Ge Peifang, Head Nurse