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Thorax pains atypical

Table of contents
Thorax pains atypical
Anamnesis and reasons of pains in a thorax
Physical inspection
Diagnostic testings

Close concepts: atypical stenocardia, retrosternal pains of not clear etiology

Before starting discussion of atypical pains in a thorax, it is necessary to define what in general means the term "typical retrosternal pain". The typical retrosternal pain, a classical symptom of coronary heart disease, means typical stenocardia. Typical stenocardia is usually shown as feeling of weight, compression, pressure or a prelum which is localized mainly in retrosternal, and often irradiates areas in a neck, a shoulder and an elbow of the left hand. At some patients pain can be absent, but they note the feeling of pressure or discomfort not similar on any another under which they ever were. Sometimes, being not able to describe words the feeling of discomfort which had by them, patients when determining the feelings use classical gesture, squeezing a hand in a fist.

Except character and localization of feeling of discomfort, typical stenocardia has several other characteristic signs. First, it usually arises at an exercise stress and disappears within several minutes of rest. Nervousness, anger, fear and other strong emotions can accelerate development of discomfort which the patient feels during physical tension. Secondly, classical anginous pain usually passes after reception of nitroglycerine within 5 min. or even quicker, and nitroglycerine kills pain much quicker, than just the termination of an exercise stress. At heart catheterization almost defeat of coronary arteries is found in 90% of patients with a classical anginous syndrome. At a classical clinical picture any diagnostic test or a combination of several tests (except for the normal angiogram of coronary vessels) do not allow to exclude a coronary disease of heart as the pain reason.

However in clinical practice of difficulty at statement of the diagnosis concern patients at whose anamnesis there are not all classical symptoms of stenocardia. The retrosternal pain can be regarded by the doctor as atypical for stenocardia due to subjectivity of the patient in the description of the state. For example, some patients use the word "acute" as a synonym of the word "heavy", others can describe pain as feeling of morbidity or as dyspepsia. There can also be atypical a description of localization of pain: some patients with stenocardia pay attention to pain mainly in a neck, hands, a shoulder and even a mandible and teeth. The atypical type of the physical activity provoking pain can mislead the doctor also. The retrosternal pain appears usually at the identical level of an exercise stress, however some patients cannot execute even small physical effort in the morning without development of heavy stenocardia, but is able to execute heavy loading in later time of day. Besides, in certain cases the retrosternal pain arises at the beginning of an exercise stress, but passes at its continuation. Other patients note emergence of stenocardia mainly after reception of a large number of food probably because the need for increase in a blood-groove for celiac area raises load of heart. At some elderly or weakened patients who lead an inactive life thorax pains can be provoked more by an emotional stress, than increase of an exercise stress. In view of a large number of atypical displays of the pain relating to a true ischemic disease it is no wonder that the large number of other states can be confused with atypical stenocardia. Pathology of costochondral connections, a musculoskeletal system of a thorax and a shoulder girdle, lungs and a pleura, a disease of a gullet and a stomach, and also a large number of heart troubles, in addition to an ischemic disease (table) concern to them.

Reasons of pain, atypical for stenocardia, in thorax

Musculoskeletal system pathology

Osteochondrosis, including a syndrome to Tittsa

Injury of muscles or sheaves

Spasms of intercostal muscles

Bursitis or tendovaginitis

Pathology  of a nervous system

Rupture of a cervical intervertebral disk

Cervical arthritis

Pathology of lungs

Pheumothorax

Pleurisy (virus, etc.)

Tracheobronchitis

New growths in lungs

Pathology   gastro
intestinal path

 

Strangulation of a hernia

Peptic ulcer

Cholecystitis

Cardiovascular pathology

Aorta stenosis

Idiopathic hypertrophic subaortal stenosis

Prolapse of the mitral valve

Pericardis

Spasm of coronary arteries

Night stenocardia

 

If to know a syndrome of typical stenocardia, then it is easy to describe the symptom complexes typical for each of these states. It is natural that the majority of problems of differential diagnosis arises when clinical signs are atypical for any of these states.



 
"Shin pains   Pains in a face"