--> Chest pain

 

The chest pain      

notes by doctor Claudio Italiano, an hospital internist

 

The chest pain depends on the different structures of the chest, parietal structures, skin, muscle, joints and organs which it contains. Parietal pain or muscular-skeletal system may depend on:

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  • muscles, tendons and bands such as myofascial pain or myogenous pain: myositis, fibrosis, tendinitis;

  • the joints and periarticular tissues as artrogeno pain: acute and chronic arthritis, periarthritis, bursitis.

  • pain from osteo-lesions neuro-muscular.

 

opacity of the right pleuraChest muscle pain is felt by the patient as a deep pain, poorly localized, which is accompanied by a sense of tension and recognizes "trigger points" or painful points, which may arise from trauma, myositis, muscle prolonged fatigue, arthritis, and it can be exacerbated by the cold and hot, with movement, muscle fatigue, and be accompanied by contractures. A type of muscle pain you have in fibrosis, namely pain of bands, muscles and ligaments

Articular structures may be points that generate pain, for example. intervertebral joints and vertebrae-rib during septic arthritis from Neisseria gonorrhoea, Staphylococcus aureus, streptococcus pyogenes. A pain of these joints also extends to the muscles that are involved in inflammation. Even the ailments of the spine can evoke pain, which are caused by traumatic, osteoarthrosic, inflammatory, or for herniated disc, cancer and osteoporosis, the connectivity and the rheumatic diseases. The pain is evoked when the ligaments are pressed by the fingers of a doctor who explores . This is due to fibrositic process. Intercostal pain may be linked to points of localized pain in the intercostal muscles during an inflammatory process, which is accentuated by the movement of breath, especially at points of Valleis and may even depend on bone metastases in the course of plasmocytoma, bone cancer and secondary primitive. It depends also on fractures or intercostal sublussazioni or concern for shingles on the part of the intercostal nerve roots, a polymiositic syndrome is caused by involvement of the muscles of the proximal muscles of the neck, scapular and track back. Is characterized as chronic pain syndrome, bilateral, night, deep fatigue, pain exacerbated by movement in the course of rheumatic disease, with muscle damage, and increase of CPK, SGOT, LDH, autoantibodies

Pleural pain.

 

Chest pain for involvement of the viscera of the chest.

The visceral pleural leaflet has little reactivity to the pain, unlike the parietal leaflet which has a sensitivity similar to that of the skin. The pain is intense, exacerbated by the respiratory movements, whether it comes from the diaphragmatic pleura, a pain is felt by the patient in the area of cucullar muscle. A pain located in the peripheral area innervated by intercostal nerves is felt in the front and basal zone of the chest or in the epigastric abdominal area. A inflammation of the mediastinal pleura is felt in the epicardium and the patient in every case has a decubitus forced on the side of pleural liquid. If the effusion is unilateral, at the percussion is valued the area of Grocco-Garland's triangle, separated by an obtuse line,and there an hypomobility lung bases is examined, the tactile thrill voice is reduced, the vesicular sound physiological is abolished.

Pain of the lung:

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the lung is sore in the pulmonary embolism, with a variable pain ranging from small to massive embolism and, in most striking form, is a deep pain, constrictive, or poorly localized retrosternal or which is associated with dyspnea and shock, with negative myocardial enzymes and blood gas ( acid-base equilibrium: analysis with significant <paO2 at 50 and paCO2 <30 mmHg. In the other case, a crisis can mimic angina. The pain in the pneumonia is determined by inflammation of the pleura, and it affects half thorax, exacerbated by breathing,urent evoked by palpation, caracterized by hypophonesis and diminishing of PHYSIOLOGICAL Murmur Vesiclar. In the lung cancer is a thoraco-brachial pain that is poorly tolerated for involvement of the pleura and costal periosteum, nerve branches, undefined and gravatar, in the scapular region. The pain in the skin and in the muscle is a parietal true, due to trophic disturbances and muscle and neurodystrophic

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Trachea and bronchi, they cause a little pain, just to flogosi and detente, and the tracheal pain is felt in the neck and the pain of the left bronchus is felt in the left breast region and that one of the right side pain to the region hypochondriacal right. In the case of cancer which interested the bronchi, the pain is indefinite. The patient can feel a pain like a weight in the shoulder or in the scapula, but if pleura is interested, it’s localized in to the lateral under breast region.

Cardiac pain: it is the pain of ischemia, a pain felt as a deep, superficial real and irradiated. Depends on the release of pain substances, such as lactic acid, or K +, after an ischemic insult, like angina pectoris and cardiac infarction pain. In the first case lasts 10-15 minutes, and it’s present in to the sternum, as the grip that tightens, urent, pierced, sensitive to nitroglycerin, itìs a somatic deep type, radiates to the left shoulder, in the upper ulnar side. In myocardial infarction is also a deep pain, but irradiated in the epigastric or restrosternale, constrictive, urent like a stab, which is accompanied by agitation psychosomatic and neuro-degenerative signs such as vomiting, sweating, hypotension and shock, hard hours and not responding to nitroglycerin, accompanied by hypocinet and hypercinet arrhythmias with upward enzymes. Is expressed as superficial and real pain localized in the sternum and in the left paravertebral and left at D2, D4, as irradiated at surface, to the arm, forearm, hand neck and jaw face.

 
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