Pulmonary embolism – sudden difficulty breathing Gall stones: look out for jaundice and pain in the right shoulder. Gall bladder, pancreas problems – pain radiates to the chestįinding symptoms such as heartburn or a bitter taste in the mouth due to stomach fluid coming up, coughing up blood, can make a cardiovascular disease unlikely. Misleading condition with shared symptoms: Digestive causes: All these conditions may cause different chest discomfort (sharp, broad, radiating) and may mislead to a cardiovascular diagnosis. Ultimately the cardinal signs should be found to be sure of the diagnosis as non-cardiac chest pain can mislead diagnosis. Reoccurrence of chest pain (misdiagnosed myocardial infarction)įinding out previous heart disease, when and how it was treated, last EKG, stress tests, and serum cholesterol levels will help in the probability of diagnosing the right cardiovascular disease.Ĥ) Are there any other symptoms that you have noticed?įinding symptoms can help in eliminating or reinforce the probability of the right diagnosis. Hypertension – chronic stress on the heartĭiabetes, hypothyroidism, dyslipidaemia, elevated blood cholesterol/triglycerides – increases the risk of myocardial ischemia, MI Previous heart surgeries – especially in the elderlyĬo-morbidities affecting the hearts such as: Past infections that went unnoticed - rheumatic fever causes damage to heart valvesĬongestive heart failure – causes hypertrophy or weakening of the myocardial wallĬongenital heart disease – abnormalities could be the cause of the discomfort That is on the myocardial wall, valves, chronically under stress (as a whole organ), tissue perfusion damage, smoking, diet, overweight and physical inactivity. The purpose of cardiovascular health history is to provide information about the patient’s cardiovascular symptoms and how they developed. Thoroughly assessing past health history will allow the understanding of the possible damage caused on the heart. However, this pattern may not be exhibited in patients with diabetes or patients taking beta‐blockers as the patient’s sympathetic tone is altered.ģ) Could you describe your past health history in detail? It is more likely to occur in the morning than in the afternoon, correlating with an increase in sympathetic tone. Myocardial ischemia may have a circadian pattern. Chest discomfort that only lasts for a few seconds or pain that is constant for days or weeks is not generally due to ischemia. The pain from myocardial ischemia generally lasts for a few minutes, whereas the pain from a myocardial infarction may be more prolonged. Understanding the duration of pain and any patterns are also helpful. Pain associated with pneumothorax, aortic dissection, or acute pulmonary embolism typically has an abrupt onset with the initial sensation being the most intense. A crescendo (intensity) pattern of pain can also be caused by oesophageal disease. Ischemic pain is most often gradual with increasing intensity over time. Knowing the onset of chest pain is vital to help determine the cause and treatment of the pain.
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Having a full description of the onset, such as the time the pain started, rhythm and cycle time, the time of sudden, prolonged or pattern like pain can relate to certain cardiovascular diseases. If the chest pain is radiating to several areas, there is an increased chance that the patient is having a myocardial infarction (MI). The pain of myocardial ischemia often radiates to the neck, throat, lower jaw, teeth, upper extremities, or shoulder. Ischemic cardiac pain is a diffuse type of non-localised pain. Pain that localises to a small area of the chest is more likely to be related to a chest wall or pleural origin rather than the heart. As many as 1/3 of myocardial infarctions may go undetected by the patient.
The severity of pain does not necessarily correlate with the degree of ischemia. Pain that responds to sublingual nitro-glycerine or cessation of activity strongly suggests a cardiac ischemic aetiology, while pericarditis pain typically improves with sitting up and leaning forward. Pain made worse by swallowing is likely of oesophageal origin. Quality of pain: a typical older patient may deny the feeling of chest pain caused by myocardial ischemia and may delay seeking treatment where timing is essential in management the typical feeling could be:īurning ‐ Infarction pain is often mistaken for heartburn or indigestion, especially in womenĬhest Constriction ‐ The ‘Levine sign’ is displayed by a patient suffering from chest pain caused by a myocardial infarctionĬhest discomfort provoked by exertion is a classic symptom of angina, although oesophageal pain can also result from exertion. To thoroughly understand the description of pain will navigate the diagnoses. 1) Can you describe your chest discomfort?ĭiscomfort: noun - slight pain.
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