Diagnosis and Treatment of Chest Pain

Diagnosis

The most important way to accurately diagnose the cause of chest pain is to focus on the patient's description and identify the location of the chest pain, how it occurs, and the characteristics of the pain. If the painful area is localized and can be pinpointed precisely, and if the pain is felt on the skin surface with sensitive pain, a musculoskeletal problem or herpes zoster is more likely. If the painful area is relatively wide, perceived as deep pain, and described as a dull pain (pressure), there is a higher likelihood of disease in an intrathoracic organ such as the heart.

If this kind of chest pain occurs very suddenly and is so severe that you have to crouch down and break out in a cold sweat, you should immediately ask those around you for help and call 119. It may be a life-threatening disease such as myocardial infarction, pulmonary embolism, or aortic dissection, so you need to go to the emergency room quickly and identify the cause and begin treatment as soon as possible. In some cases, severe chest pain may go away, but even in such cases, you should go quickly to the emergency room at a large hospital. In the case of aortic dissection, if the symptoms disappear and then return, it is a serious problem that can lead to death. If chest pain persists, a doctor's consultation and examination are essential, and if the chest pain feels severe enough to make daily activities difficult, you should go to the hospital quickly even if the symptoms last only a few minutes.

If you visit the hospital because of chest pain, tests such as an electrocardiogram, blood tests, and chest X-rays are performed to differentiate heart- and lung-related diseases that could be life-threatening. Depending on the patient's condition and the suspected situation, diagnosis is made using ultrasound, CT, MRI, or endoscopic examinations.

Self-diagnosis of Chest Pain

Out of 100 patients who visit a hospital, 1 complains of chest pain. Chest pain can be felt in various forms, such as stabbing pain, pressure pain, or a burning sensation, and the causes can vary, including heart disease, lung disease, esophageal disease, musculoskeletal disease, and psychiatric disorders.

Among 100 patients with chest pain, 60 have pain triggered by psychological causes or an unknown cause. Of 100 patients with chest pain, 35 have musculoskeletal disease, 13 have esophagitis, and about 11 have heart problems (angina pectoris). Even in the United States, where cardiovascular disease is common, only 1 to 2 out of 100 patients with chest pain have unstable angina or myocardial infarction.

However, it is difficult to accurately infer the cause of chest pain from symptoms alone.

Treatment

If angina pectoris or myocardial infarction is diagnosed, medication to prevent blood clots is started immediately, and depending on the severity confirmed by detailed examinations, a procedure to remove blockages in the coronary arteries, a procedure to widen the blood vessels by inserting a device called a stent, or coronary artery bypass surgery, in which a blood vessel from another site is taken to reconnect the heart vessels, will be performed. Aortic dissection is an emergency that can be a matter of life and death, and surgery is performed immediately upon diagnosis. If gastroesophageal reflux disease is confirmed, symptoms may improve by taking medications that suppress acid secretion in the stomach (acid suppressants). However, if you do not change habits such as heavy drinking, overeating, smoking, and stress, the symptoms recur. It is very important to have a light dinner and not lie down within 2 hours after eating.

Chest pain caused by a chest strain or coughing is characterized by pain that lasts for a few seconds and then disappears briefly, whether mild or severe. Also, it hurts only when moving or coughing, and does not hurt when remaining still. In addition, if you take painkillers, the symptoms improve within a few hours and disappear within a few days, or at the latest within 3 weeks. Even if a rib is fractured, it will heal on its own if there are no complications (such as pneumothorax or hemothorax). In this case, chest pain may last for up to 3 weeks, but if you usually take painkillers, the symptoms improve greatly within 1 week and disappear within 4 weeks.

Herpes zoster is a terrifying condition for the elderly and frail. It most often occurs on the chest and can be a cause of chest pain, but it can also occur on the face, abdomen, or thighs. The most important part of herpes zoster treatment is to administer antiviral agents promptly. Simply giving painkillers by injection or oral medication does not reduce the pain. Therefore, if herpes zoster is strongly suspected, antiviral agents may be administered even before skin blisters appear. It is known that receiving a recently commercialized herpes zoster vaccine can reduce the incidence of herpes zoster, and even if it does occur, the symptoms are milder.

So far, I have explained the diagnosis and treatment of chest pain.

In the next installment, we will learn about flat feet.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal