Patients with sudden chest pain must be particularly scared. After all, the scene of heart disease patients suddenly covering their chests and dying is too deeply rooted in people's hearts. Although there are fatal possibilities such as acute myocardial infarction, aortic dissection and pulmonary embolism, there are also non-fatal chest pains such as mitral valve prolapse, pleurisy, esophageal diseases, cardiac neurosis and musculoskeletal diseases.
Nip in the bud!
Although it is very possible, if you suddenly have chest pain, it is recommended to go to the hospital for diagnosis in time if conditions permit!
Chest pain is a common symptom, but it is also a very serious symptom. Because there are many people involved, myocardial infarction that may be fatal is also very common, so patients must be vigilant.
Three high-risk possibilities!
It is the three possible fatal chest pains I mentioned above!
Acute myocardial infarction: squeezing chest pain similar to angina pectoris is a dull pain, but it is often more severe. The main pain range is behind the sternum, which may radiate to other parts, about the size of a fist, and nitroglycerin cannot relieve it.
Aortic dissection: Patients with this kind of disease often feel a kind of heart-wrenching chest pain, mostly persistent pain, and most patients may appear pale and sweaty.
Acute pulmonary embolism: patients may have knife-like chest pain, accompanied by chest tightness symptoms. Once they take a deep breath, the pain may get worse and become more severe and unbearable.
The possibility of not needing treatment!
This kind of chest pain is called cardiac neurosis. The so-called no treatment means no surgery or drug treatment, but patients need to adjust their living and eating habits and maintain a positive mental state in order to recover in a short time.
This is due to the formation of its disease. This kind of patients have no organic lesions, so they can't detect abnormalities through imaging examination, and menopausal women are more prone to this disease. At the same time, staying up late and working overtime, long-term high pressure, smoking and alcoholism are all high-risk factors. Under the combined action of these factors, the patient's nervous system will be disordered, leading to a series of clinical symptoms. Because there is no organic disease, modern medicine is extremely effective for its treatment and needs more self-regulation and recovery, as I said above.
The possibility of easy misdiagnosis!
This kind of chest pain is easily misdiagnosed as cardiac neurosis. When the patient suspects this kind of disease, go for an examination. Once no problem is found, it will be suspected of cardiac neurosis. But we need to understand that the so-called no abnormality is not necessarily true, and it is probably a mistake, which requires doctors to guess the disease before the examination, so as to make a correct judgment.
This kind of chest pain, which is easily misdiagnosed, is caused by spinal lesions. There are obvious responsible lesions, which can be found by MRI and X-ray. However, because many doctors ignore this point, it is easy to miss the diagnosis. In fact, there are a large number of patients with so-called cardiac nerve function. They have long-term symptoms such as chest pain and chest tightness. Even if they take sedatives regularly, go to bed early and get up late, keep enough rest time and travel regularly to ensure a happy mood, their symptoms have not been alleviated.
Such patients need timely treatment, otherwise, with the passage of time, the coronary artery continues to spasm and the blood circulation has been blocked, which is likely to form plaques to block blood vessels, leading to the emergence of myocardial infarction and life-threatening.
There is a common sense concept that needs to be emphasized again: although chest pain is not necessarily a heart disease, and heart disease is not necessarily chest pain, all symptoms of chest pain should be highly valued.
In fact, there are many diseases that cause chest pain, which can be light or heavy, urgent or slow.
For every clinical medical student, the problem of chest pain must be often encountered and asked.
Herpes zoster, costal chondritis, intercostal neuralgia, pneumonia, pleurisy, pneumothorax, esophagitis, aortic dissection, myocardial infarction and pulmonary embolism can all cause chest pain.
In addition, heart disease is just a general term for heart-related diseases, which contains many contents.
Among them, what we want to express most is probably: acute myocardial infarction.
It needs to be emphasized again that acute myocardial infarction does not necessarily have typical chest pain, and even has some atypical other symptoms.
For example, I have seen patients with acute myocardial infarction, and there is no chest pain, only diarrhea.
I have seen patients with acute myocardial infarction and aortic dissection with "stomachache" as the only symptom.
I have seen patients with acute myocardial infarction whose first symptom is syncope.
I have also seen patients with acute infarction whose main symptoms are toothache and numbness and pain in upper limbs.
I have even seen patients with acute myocardial infarction whose main symptom is "mental disorder".
Therefore, we can neither think that acute myocardial infarction will definitely have symptoms of chest pain, nor alarmist that all chest pain may be acute myocardial infarction.
But in any case: once chest pain occurs, we should pay attention to it and go to the hospital for treatment, especially for middle-aged and elderly patients and high-risk groups such as hypertension, diabetes, excessive smoking and staying up late. Because, we don't know if we are hovering between life and death!
Chest pain is a precursor to heart disease!
You may see that many chest pain centers have appeared in various cities in the last year or two. One of the purposes of establishing so many chest pain centers is to identify chest pain with the fastest, most accurate and most professional speed and rescue patients with heart disease, that is, patients with acute myocardial infarction.
Among all chest pain diseases, the incidence of acute myocardial infarction is the highest, and the mortality and disability rate are relatively high. In the rescue process of acute myocardial infarction, every minute counts, so the establishment of chest pain center can rescue acute myocardial infarction faster and more accurately, establish a green channel and really put life first.
Chest pain is just a symptom. Not all chest pains are acute myocardial infarction. In this case, an acute myocardial infarction center will be established. Just because chest pain is only a common clinical manifestation, there are many diseases corresponding to chest pain, such as acute myocardial infarction, aortic dissection and pulmonary embolism. Today, I only briefly introduce the characteristics of heart disease chest pain: angina pectoris is mostly paroxysmal, with fixed position but not limited. Every time it takes about 2- 15 minutes, it will definitely get better, which is more than the onset or aggravation after fatigue, and has nothing to do with body position. If angina persists, it is a myocardial infarction!
Besides the above acute myocardial infarction, aortic dissection and pulmonary embolism, it may also be pericarditis, pleurisy, herpes zoster, cardiac syndrome X, acute dermatitis, subcutaneous cellulitis, myositis, intercostal neuritis, rib fracture, acute leukemia, multiple myeloma, myocarditis, pleural tumor, spontaneous pneumothorax, pneumonia, lung cancer, mediastinum, mediastinal abscess, mediastinal tumor, esophagitis, etc.
Therefore, chest pain may be a heart disease, and it is really necessary to consider whether it is a heart disease first. Once the chest pain persists, be sure to call 120 as soon as possible!
Many diseases can cause chest pain, the most common disease is of course heart disease, which is a general term, including many diseases, such as acute myocardial infarction, hypertrophic cardiomyopathy, dilated cardiomyopathy, heart valve disease, myocarditis and so on. All these diseases can cause chest pain.
For example, a middle-aged and elderly person with a history of hypertension may have chest pain during recent activities, which can be relieved after rest. At this time, we should highly consider whether it is angina pectoris, which is a kind of coronary heart disease and must be taken seriously. When the blood vessels of the heart harden and narrow, if physical activity is carried out, the heart will be relatively ischemic at this time, and ischemia will be very painful. Once you have a rest, your heart will slow down and the pain will be relieved.
But not all chest pains are angina pectoris. If so, it would be too easy to be a doctor. Chest pain may also be the manifestation of hypertrophic cardiomyopathy and dilated cardiomyopathy, and the diagnosis of these diseases can only be differentiated by color Doppler echocardiography. Chest pain may also be aortic stenosis. When the aortic valve is narrowed, blood can't be pumped out, so the whole body will be ischemic, and the heart itself will be ischemic, leading to angina pectoris.
In addition, ruptured aortic dissection can also cause chest pain. Rupture of aortic dissection is an extremely dangerous disease. At this time, due to the torn artery, there will be very obvious chest pain, usually a tearing pain in the back. If the progress is rapid, patients often have no time for surgery and die directly.
In addition, chest pain is more likely to be inflammation of some soft tissues, especially young patients who often exercise. Because it will inevitably hit the chest soft tissue, it will lead to local soft tissue inflammation, such as costal chondritis. There will be chest pain at these times, but these chest pains are not serious, not a sign of heart disease, so don't be too nervous. How to differentiate costal chondritis? Just press it with your finger If you feel pain in this place and then press it with your finger, the pain will be even worse, indicating the pain caused by inflammation in this part, so it's okay. Just take some antipyretic and analgesic drugs orally, such as ibuprofen and loxoprofen.
Therefore, not all chest pain is a prelude to heart disease, only some diseases are. Specifically, these require a comprehensive assessment by doctors.
About chest pain, it is very necessary to talk to you! Due to the publicity and education on the prevention of coronary heart disease such as myocardial infarction in recent years, most people directly equate chest pain with myocardial infarction, which is indeed a very good awareness of preventing myocardial infarction, but in fact chest pain is not necessarily a precursor of heart disease. What I want to emphasize to you is that when chest pain occurs, you should learn these simple differential diagnosis methods!
First, chest pain is not necessarily a manifestation of heart disease, but also esophageal reflux!
The position of esophagus and heart is relatively close, and some people often think that they have heart disease. In fact, esophageal chest pain caused by esophageal reflux is different from chest pain caused by myocardial infarction. Chest pain caused by esophageal reflux is often more frequent after eating a full meal, and the pain is faint, not colic caused by myocardial infarction, and lasts longer than chest pain caused by myocardial infarction, which often brings the feeling of acid reflux, and the patient stands upright.
Second, chest pain is not necessarily a myocardial infarction, but also a manifestation of other heart diseases!
A large number of patients with myocardial infarction will have chest pain symptoms, but clinically, some heart diseases will also cause corresponding chest pain symptoms, such as aortic dissection, pericarditis, pericardial tamponade, mitral or aortic valve disease, aortic aneurysm, aortic sinus aneurysm rupture, dissecting aneurysm and so on. These will all lead to chest pain. Therefore, it is very important to diagnose what kind of heart disease chest pain is. For example, chest pain caused by aortic dissection aneurysm, once misdiagnosed, the mortality rate will reach more than 90%. Therefore, if you have chest pain symptoms, you must go to the hospital chest pain center in time to check the cause!
Third, myocardial infarction should not only be aimed at typical chest pain symptoms, but also asymptomatic myocardial infarction deserves our attention!
The typical symptoms of chest pain are more likely to attract people's attention to the disease, but some patients with myocardial infarction belong to asymptomatic myocardial infarction. They have no chest pain or radiation pain, which may be symptoms such as sweating and fatigue before myocardial infarction, but it may actually be a precursor to myocardial infarction, and we should pay attention to it. If you can't relieve it in time, you must seek medical advice in time, because asymptomatic myocardial infarction is more likely to be ignored and fatal!
Heart disease can cause chest pain and chest tightness, but chest pain is not necessarily a precursor of heart disease.
First of all, there are many kinds of heart diseases, the most common one is coronary heart disease, and the most common clinical manifestation of coronary heart disease is angina pectoris, so people may think that heart disease is the manifestation of frequent chest pain.
But is chest pain, in turn, a precursor to heart disease? The answer is no, in fact, chest pain is a very common symptom. There are many diseases that can cause chest pain, including hundreds of diseases such as cardiovascular system, respiratory system and digestive system, some of which do not require special treatment, while others are fatal. Common fatal chest pains include myocardial infarction, aortic dissection and pulmonary embolism. Non-fatal diseases include intercostal neuralgia, cardiovascular neurosis, reflux esophagitis, lung cancer, stomach disease, herpes zoster, pericarditis, costal chondritis and so on.
Of course, among these chest pains, angina pectoris is the most common and the most harmful to human body. Simply put, if there is a sense of oppression, squeezing pain and cold sweat in the precordial area related to activities. A few minutes' rest will obviously relieve you, so you must go to the hospital in time. Especially those with family history of hypertension, diabetes, hyperlipidemia, smoking and early cardiovascular diseases should go to the hospital for emergency treatment in time. If it is the first unexplained chest pain, it is best to go to the local chest pain center for further diagnosis. At present, 669 chest pain centers have been set up in 3/kloc-0 provinces and cities across the country, and a national chest pain rapid treatment network has been established, which can make heart patients get rapid treatment in the first time.
Chest pain is not a disease, but a symptom, and it is very common. Inflammation, vascular disease, trauma, tumor and any other factors. Clinically, as long as the sensory nerve innervating the chest is stimulated, it will manifest as chest pain. Due to the different causes of chest pain, the manifestations and pain degree of chest pain are also different, including dull pain, tenderness, burning pain, tingling and tenderness. Some pain will radiate to other parts, some are local, some are related to breathing and exercise, and some are manifested as chest pain at rest.
There are more than 50 diseases that can cause chest pain. Most patients with chest pain are not life-threatening, but a few are caused by fatal diseases. Therefore, chest pain is not necessarily a heart disease.
If it is related to the heart, the common disease is acute coronary syndrome, and 80% to 90% of sudden cardiac death is caused by ACS. Therefore, when chest pain occurs, it is necessary to quickly identify whether the patient has fatal chest pain.
Chest pain can basically be divided into four categories:
1, chest wall diseases, such as herpes zoster, epidemic chest pain, intercostal neuritis and trauma.
2. Respiratory diseases, such as pleurisy and pneumonia.
3. Cardiovascular diseases, such as angina pectoris, acute myocardial infarction and aortic dissection.
4. Other conditions, such as mediastinal diseases, digestive system diseases, neck diseases, physical and mental diseases, etc.
Different diseases show different characteristics of chest pain:
Chest wall disease: there is obvious tenderness locally, and the pain site is the lesion site.
Respiratory system diseases: the painful parts are armpits and quarter ribs, and breathing will aggravate the pain, which may be accompanied by symptoms such as cough, hemoptysis and dyspnea.
Cardiovascular disease: Pain is mostly concentrated in the posterior sternum or precordial area, and the boundary is usually not obvious. The nature of pain is dull pain, not stinging pain. Angina pectoris will radiate to his left shoulder and left arm for a short time. Patients are often accompanied by chest tightness, sweating, nausea and vomiting, pale face and blue lips. Most of them occur in middle-aged and elderly people with cardiovascular risk factors.
The most common chest pains caused by cardiovascular problems are angina pectoris and acute myocardial infarction.
It is characterized by a history of heart disease in the past, and the pain is mostly confined to the posterior sternum and precordial area, and can also be seen in the upper abdomen and back, reflecting to the left shoulder, and the pain is aggravated when you are tired or emotional. The pain nature of acute myocardial infarction is mostly dull pain, tenderness, tingling, colic, knife pain and so on. Oral nitroglycerin can not relieve. A few people can only show dull pain or oppression in the chest. Pain lasts for several hours to several days, often accompanied by sweating, irritability, pallor, and sometimes blood pressure drops and arrhythmia. The pain site of angina pectoris is the same as that of acute myocardial infarction, but the pain is mild, which can be relieved by taking a few minutes' rest or nitroglycerin. The most common reasons are physical activity, emotional excitement, after a full meal, smoking and cold stimulation.
The pain of angina pectoris and myocardial infarction is severe in nature, wide in scope and long in duration, and the effect of oral nitroglycerin is not good.
And aortic dissection and pericarditis. The pain of pericarditis varies greatly, from mild dull pain to persistent severe chest pain.
Most chest pains are not manifestations of insufficient coronary blood supply, so there is no need to easily suspect that you have a heart disease.
If it is pain in the precordial area (under the nipple, at the apex of the heart or at a certain point in the chest), this pain has no close relationship with physical activity or emotion, and can be manifested as persistent dull pain or dull pain, which lasts for several hours to several days and often occurs after intense mental work; It can also be a very short-lived (only 1.2 seconds) and fleeting needle-like pain, which can occur repeatedly. Both kinds of pain can be accompanied by local skin allergies or local tenderness points. This is also one of the clinical manifestations of nervous system allergy or autonomic nervous dysfunction.
People without organic heart disease in the past can't be ignored if they have unexplained palpitations, shortness of breath and fatigue. If it occurs after respiratory or digestive tract infection, the possibility of myocarditis cannot be ruled out; If the above symptoms appear after overwork and heavy smoking recently, you should be vigilant. You should go to the hospital to check ECG, myocardial injury markers or color Doppler echocardiography in time.
If there is acute chest pain, the key is to find out the cause and treat it. For patients over 40 years old with a history of coronary heart disease, when severe pain occurs in the precordial area, attention should be paid to whether it is acute myocardial infarction. You can take nitroglycerin sublingually first. If it doesn't relieve, you should go to the hospital immediately. If chest pain is localized and tenderness is obvious, it may be a chest wall disease. It can be treated with analgesic ointment or oral analgesic tablets, and the general symptoms can be alleviated. Patients with long course of disease and other obvious accompanying symptoms should not be treated by themselves. It is best to go to the hospital as soon as possible to avoid delaying treatment.
First of all, there are many kinds of heart diseases. The heart diseases here are mainly angina pectoris and myocardial infarction.
Characteristics of angina pectoris and myocardial infarction pain
Most angina pectoris and myocardial infarction will have anterior pain, which is often anterior pain, with a sense of squeezing and slapping. If angina pectoris is relieved after ten minutes, even taking nitroglycerin or quick-acting Jiuxin pills under the tongue, if it is a myocardial infarction, the pain will not be relieved. But not all chest pains are heart diseases.
There are many reasons for chest pain.
There are many reasons for chest pain, such as daily esophagitis, intercostal neuralgia and more dangerous aortic dissection, which will all cause chest pain.
Different chest pains must be treated differently. If chest pain is manifested as precordial area, large palm, squeezing feeling and radiating to the left shoulder, especially nitroglycerin or quick-acting Jiuxin Pills can be relieved, it can basically be determined to be a heart disease. At this time, you must go to the hospital in time to determine the condition of your heart and blood vessels and whether you need further treatment.
Not all hearts have chest pain.
We should also make it clear that not all angina pectoris or myocardial infarction have chest pain.
Some people will have symptoms of other troops, such as nausea and vomiting, and even some people have toothache and neck pain, and some people have atypical symptoms such as stomach pain.
These may also be caused by heart disease. When we have these symptoms, we must not forget that this may be a heart disease.
What tests do you need to do to go to the hospital in this situation?
First of all, you must do an electrocardiogram to see if there is any change in cardiac ischemia, and also draw blood to check myocardial enzymes and troponin. The third is to do color Doppler ultrasound and coronary angiography when necessary to see whether the whole heart function is normal and whether there are problems with the heart blood vessels.
Rule out whether there is heart disease, because aortic dissection is also fatal in other chest pains, which is tear-like pain and even more dangerous than the death rate of myocardial infarction.
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There are many reasons for chest pain, and it is also a symptom that is difficult to distinguish clinically. The most dangerous thing is chest pain caused by two reasons, one is aortic dissection and the other is acute myocardial infarction.
Aortic dissection has a low incidence rate but a high mortality rate. Within 48 hours after onset, the mortality rate is close to 50%. Pain is a tearing pain in the chest and back.
Acute myocardial infarction is caused by acute coronary occlusion, which leads to myocardial ischemia and necrosis. If the occluded blood vessels can be opened as soon as possible through thrombolysis or coronary stent, the prognosis will be better. In recent years, people have become more and more alert to chest pain, and more and more people call an ambulance to go to the hospital. At present, many hospitals in China have chest pain centers for emergency coronary intervention.
Heart disease will have chest pain, chest tightness, shortness of breath and other manifestations, then chest pain is a harbinger of heart disease? In fact, chest pain is not necessarily a precursor to heart disease. Other diseases such as digestive tract diseases, respiratory tract inflammation, intercostal neuralgia, pleurisy, pleural thickening and aortic dissection can all cause chest pain. It needs to be treated differently to know the cause of chest pain.
First of all, when angina pectoris and myocardial infarction occur in patients with heart disease, the pain site is often in the precordial area, with a sense of oppression, palm pain, which radiates to the left shoulder. It can be relieved after containing nitroglycerin or quick-acting Jiuxin Pills, which can basically be identified as heart disease. You need to go to the cardiology department of the hospital in time. First of all, you should do an electrocardiogram to see if there is any change in heart ischemia. Blood should also be drawn to check myocardial enzymes and troponin. If necessary, color Doppler ultrasound and coronary angiography should be done to see if the whole heart function is normal and cardiovascular problems exist. Then decide whether further treatment is needed.
If it is determined that chest pain is not caused by heart disease, it needs to be considered that it is caused by other reasons, such as aortic dissection, respiratory infection, pleurisy, reflux esophagitis, lung cancer, stomach disease, costal chondritis and so on. If the position of chest pain is fixed, there is tenderness and swelling in the local area, which may be caused by inflammation. If it is burning pain, it may be caused by acid reflux. If the pain is like a knife, it may be caused by herpes zoster. If chest pain is accompanied by cough and expectoration, it may be caused by lung disease. Need to go to the hospital chest surgery to further diagnose the cause, if the cause of chest pain is clear, it is necessary to give analgesic treatment, commonly used antipyretic and analgesic drugs, but also opioid drugs; For some other accompanying symptoms, we should also give corresponding symptomatic treatment. Usually pay attention to avoid smoking and drinking, and avoid warm and spicy food. Paying attention to emotional relaxation is helpful to prevent chest pain symptoms.