PATHOLOGICAL CONSIDERATION OF ACUTE CHEST PAIN
Chest pain is among the most every now and again assessed introducing complaints in the emergency department (ED). Diagnostic etiologies range from benign to life-debilitating. Inability to diagnose the life-debilitating chest emergencies can prompt to catastrophic medical and legal results for the patient and physician separately (Boie, 2005).
The first approach to assessing chest pain incorporates excluding life threatening reasons, which for the most part incorporate (1)coronary artery disease (Kettunen and Talvensaari ,2009) (2)acute aortic syndrome (AAS) (3)pulmonary embolism (PE) (4)esophageal rupture (5)tension pneumothorax and (6)pericardial tamponade (Butler and Swencki, 2006). I-Pathology of Pulmonary embolism (PE):
As the third most common reason of cardiovascular death after myocardial ischemia and stroke, pulmonary embolism (PE) is a conceivably fatal condition connected with significant morbidity and mortality (Araoz et al., 2007).
PE and DVT are two clinical presentations of venous thrombo-embolism and offer the same predisposing factors. In many cases PE is a result of DVT (Pitts et al., 2008).
Thrombi generally form in the deep veins of the calf and after that propagate into the proximal veins, including and above the popliteal veins, from which they will properly embolize. Around 79% of patients who present with pulmonary embolism have
A DVT is a blood clot that can occur anywhere in the body, but these blood clots tend to occur in the deep veins of the legs and thighs. It is critical that these clots are diagnosed and treated promptly to prevent further complications such as a pulmonary embolism, which occurs when a blood clot travels from the lower extremities
To determine if the patient’s chest pain is related to injury, you would look for ST-segment elevation. Myocardial injury represents a worsening stage of ischemia. If ST-segment elevation is greater than or equal to 1mm above the isoelectric line, it is significant and treatment needs to be prompt and effective to try to restore oxygen to the myocardium, and to avoid or limit infarction. The absence of serum cardiac markers confirms that infarction has not
Prior to starting medical treatment, I would like to obtain an ECG first to make sure that your chest pain is not related to any heart disease. GERD is most likely the cause of noncardiac chest pain, but it is important for patient safety that we get an ECG to make sure that we don’t overlook the possibility that you are having any cardiac symptoms (Buttaro et al., 2017).
It is applicable to obtain arterial blood gases (ABG) or pulse oximetry for patient experiencing a severe exacerbation (Booker, 2014). Chest X-ray and ECG
The physician was notified of the pain and discomfort related to the chest tube, which pain medication was given. Other notifications were the amount of drainage from both the chest tube and the JP. Both were under normal limits. SOB and fatigue with activities were also notified to the
Cook County was having more patients than it could handle complaining about chest pain. Also, determining if the pain could be a heart attack was a very inefficient and a long process with too much information. So they streamlined the process, mainly considering 4 things which were the EGG, fluid in lungs, systolic pressure, and unstable angina. The results were more accurate and saved time. This showed that, sometimes with too much information, there is too much of the complicaticated information and an answer can’t be reached and with less information a correct answer can be reached quickly.
Mr. S was driving when he experience a stabbing chest and back pain for the first time. The pain was so severe he immediately went to his local ER. Pulmonary ventilation and perfusion (VQ) scan and Computed tomography angiography (CTA) was done at his local ER. VQ scan was negative for pulmonary embolism (PE). CTA of the chest revealed
chest pain are due to the lack of oxygen and reduces in oxygen exchange at
Mr. Steward was pain free until this morning. He initially complained of right-sided chest pain and then complained about pain in his hip and ankle. We recognized this was a new onset of pain that persisted, despite giving him some pain medication. When Mr. Steward was discovered in his room clutching his chest, we recognized this as a non-verbal sign of pain and asked him whether he was having chest pain. Although Mr. Steward doesn 't provide a definitive answer, he displayed non-verbal signs of pain, such as restlessness, frequent shifting in bed, and act of clutching his chest. Recognizing Mr.
A DVT is a thrombus or blood clot that most commonly occurs in deep veins in the leg or pelvis. DVTs usually start distally in the veins of
Chest pain is posed as life threatening-has many definitions ranging from either stabbing, dull, crushing or burning. In certain cases, pain travels up the neck, the jaw, can radiate to the back or down one or both arms. Many different problems can cause chest pain and it can be difficult to determine the exact cause of chest pain (Burman et al’, 2011). Patients’ experiencing chest pain is symptoms consistent with, myocardial ischemia and is a common reason for presenting to ED (Pub Med Central, 2010).
Pulmonary embolism (PE) accounts for up to 30,000 deaths each year. (Beckman, 2014). It has been estimated that nearly one-third of deaths stemming from pulmonary embolism occur within the first hour. (Muckart, 2010). It can prove to be extremely difficult to diagnose pulmonary embolism due to the wide range of symptoms and presentations, or lack there of. (Muckart, 2010; Tarbox & Swaroop, 2013). Some patients with acute pulmonary embolism, possibly as many as 50%, are completely asymptomatic. (Muckart, 2010). Although the clinical presentation can vary dramatically, some of the main symptoms include tachycardia, sub-sternal chest pain, dyspnea, hypoxemia, hypotension and even possibly shock. (Tarbox & Swaroop, 2013). There are several risk factors attributed to PE, including but not limited to, recent immobilization, previous myocardial infarction or cerebral vascular accident, prior surgery or recent trauma. (Tarbox & Swaroop, 2013). Initial symptoms primarily present with severe respiratory distress, but the main adverse effects of PE effect the cardiovascular system due to the fact that the embolus causes an occlusion in the pulmonary vasculature. (Muckart, 2010). The obstruction within the pulmonary artery vastly increases vascular resistance, which results in right ventricular failure; therefore the left ventricular preload is minimized and cardiac output collapses. (Muckart, 2010).
Chest X-ray: Though not used for diagnosis, can show signs of conditions that resemble PE.
Chest pain is a very common symptom, and around 20% to 40% of the general population will experience chest pain in their lives(149). In the UK, up to 2 % of visits to a general practitioner are due to new onset chest pain (150). Approximately 5% of visits to the emergency department are due to a complaint of chest pain, and up to 40% of emergency hospital admissions are the result of chest pain(149, 151). Approximately 52,000 new cases of angina per year are diagnosed in men and 43,000 in women. The incidence of angina increases with age(123).
A Deep Venous Thrombosis (DVT) will propagate when there is either stasis of blood flow, endothelial injury, or if the patient is in a hypercoagulable state. Under physiological conditions, a dislodged DVT can predictably settle in the pulmonary arteries causing a pulmonary embolism. However, a DVT in the presence of a intracardiac shunt or PAVM can paradoxically cause an embolism in branches of the aorta. The pathophysiological mechanism varies depending on the etiology of the paradoxical embolism. For instance, in a paradoxical embolism due to a PFO, a DVT gets dislodged and enters the right atrium where a transient increase in right atrial pressure during a Valsalva maneuver can force the embolism through the PFO and into the left atrium