does all my patients all have chest pain

Not surprisingly, patients with a history of myocardial infarction are likely to be found to have coronary disease as the cause of recurrent episodes of pain. Accompanying symptoms are most helpful diagnostically when they occur in close proximity to the episodes of pain. The patient should be asked to describe the temporal relationship between the pain and associated symptoms. Dysphagia, nausea, and vomiting suggest a gastrointestinal etiology. Diaphoresis frequently occurs in acute myocardial infarction. Cough or dyspnea suggests pulmonary disorders. Symptoms accompanying chest pain often provide diagnostic clues. Coronary disease rarely causes episodes lasting more than 12 hours without electrocardiographic changes of acute myocardial infarction. Episodes of pain caused by coronary disease usually last less than an hour. The frequency and duration of pain should be defined, although these data are less helpful in distinguishing the cause of attacks. Pain caused by coronary disease is more likely to require patients to stop their usual activities. Whether or not the pain is caused by exertion, its severity provides a clue to its etiology.

Similarly, improving exercise tolerance is strong evidence that a treatment regimen has been effective. Patients with a history of recurrent pain that now occurs with decreasing levels of exertion may require urgent treatment. Such pain usually is not caused by coronary artery disease.įor patients reporting chest pain brought on by exertion, clarify the amount of exertion required to cause the pain. Patients occasionally will attribute pain to exertion, but careful questioning will reveal that the pain comes and goes with deep breaths or body movements during heavy exercise. Pain that is pleuritic or is brought on by moving the arms or torso is less likely to be caused by coronary disease. Patients with coronary disease frequently report pain brought on by emotional stress or sexual intercourse. If the patient notes that less exertion is required to cause the pain when going out in cold weather or after eating a large meal, then the pain is likely to be caused by coronary artery disease. Angina usually becomes worse with exertion and is relieved by rest. The most important part of the chest pain history is to define what aggravates and relieves the pain. While radiation of the pain to the left arm is typical of angina, patients with coronary artery disease also frequently have pain that radiates to the right arm or neck. Pain located exclusively in either the left or right chest is atypical. Anginal pain is usually located substernally or across the anterior chest. Sharp, stabbing, or burning pain is less typical of angina. The patient may describe a pressure sensation rather than a true pain. Anginal pain is typically described as dull, heavy, or crushing. Patients should be asked to describe the quality of their discomfort in their own words. Angina pectoris is a recognizable pain syndrome, and careful attention to the features of the history aids the clinician in determining whether a patient's pain is typical of angina pectoris. Coronary arteriography studies have demonstrated that patients with pain typical of angina pectoris are more likely to have obstructive coronary disease than are patients with atypical pain syndromes. A central goal is to determine whether the pain is likely caused by myocardial ischemia. Precise definition of the pain allows the list of possible causes to be narrowed and guides the physical examination and choice of diagnostic tests. Because the probable etiology often can be determined from the history alone, the clinician should systematically evaluate characteristics of the pain. Chest pain is one of the most common symptoms for which adults seek the care of a physician.

Does all my patients all have chest pain