Approach to Chest Pain
Upon presenting to your doctor with chest pain, a rational and step-by-step approach to diagnosing the cause of the pain will be followed. This will include a thorough case taking and physical examination which may be followed by tests and investigations to exclude or confirm differential diagnoses.
Chest Pain Medical Emergency
There are red flag signs and symptoms associated with chest pain that require immediate medical intervention.
This includes :
- Loss of consciousness.
- Signs of shock.
- Abnormal vital sounds – pulse, breathing rate, blood pressure.
- Dyspnea (shortness of breath).
- Heart murmurs.
Case Taking and History
Assisting your doctor by providing pertinent information for a quick chest pain diagnosis will allow for the appropriate treatment to be administered as soon as possible.
The main features of your chest pain that should be divulged include :
- Location of the pain. Apart from the main site of the pain, any other areas that are painful should also be mentioned.
- Duration of the pain. It is also important to mention any events that may have preceded the pain that could be a possible cause or contributing factor.
- Nature of the pain. This may be constant, intermittent, episodic, of sudden onset or insidious. It may be a caused by certain activities like during physical exertion or after certain conditions like after eating.
- Type of pain. This may be sharp, stabbing, dull, aching or burning pain. Explain the type of pain in your own words.
- Quality of the pain. The pain may be severe and intolerable or mild and bearable.
Chest Pain Symptoms
Apart from the chest pain, you may be experiencing other symptoms which should be mentioned to your doctor. Some of the common symptoms associated with chest pain include :
- Dizziness, light headed feeling or fainting spells.
- Difficulty breathing or shortness of breath.
- Profuse sweating.
- Fatigue, malaise or weakness.
- Fever and/or chills.
- Nausea and/or vomiting.
- Referred or concomitant pain.
- Swelling particularly of the legs.
Some of these signs and symptoms may have preceded the chest pain, occurred simultaneously with the onset of the pain or presented after the chest pain began.
Divulging your entire medical history is imperative, especially if the attending physician is not your family doctor. Pertinent information will include the following :
- Past medical history. Other serious medical illnesses that you have previously experienced including childhood diseases.
- Chronic conditions.
- Family history.
- Drug history. This includes pharmaceutical drugs and/or narcotics.
- Risk factors, particularly those related to the development of a cardiac condition, should also be mentioned. This may include tobacco use, alcohol abuse, previously detected but unconfirmed hypertension, hypercholesterolemia, impaired glucose tolerance/diabetes and angina.
Your doctor will first record your vital signs – pulse, blood pressure, breathing rate and body temperature. Your weight and height will also be measured to assess your body mass index (BMI). A finger prick blood glucose test and urine dipstick may also be done if your doctor suspects any related conditions. At this point, your doctor may consider a general physical examination carefully assessing for the following features :
- Jaundice. Yellowish tinge of the skin and conjunctiva of the eye which may be a sign of a liver disorder.
- Anemia. Paleness of the skin and nails indicative of low blood iron, red blood cells or blood loss.
- Clubbing. Fleshy, club-like appearance of the fingers and toes indicating a possible respiratory disorder.
- Cyanosis. Bluish tinge of the fingers, toes, lips or entire body indicative of an inadequate oxygen supply.
- Edema. Swelling of a specific area, particularly the legs or abdomen or generalized swelling.
- Lymphadenopathy. Enlarged lymph nodes which may indicate an infection or cancer.
- Higher functions. Your cognitive functions and memory.
- Hydration. Skin turgor, dry mouth and sunken eyes may be signs of dehydration.
The assessment above is done quickly and followed by a system examination. This includes :
- Palpation of the chest to detect any tender areas which could indicate bone fractures or soft tissue injury. Visual inspection may also reveal areas of inflammation or a skin rash.
- Percussion and auscultation of the lungs to detect abnormal breathing sounds, fluid in the lungs or consolidation of the lungs.
- Auscultation of the heart and major vessels to detect any abnormal heart sounds, valve murmurs , fluid around the heart or bruit (abnormal sound produced by a major artery like the aorta).
- The arterial pulses are examined, particularly those of the leg and neck and any sign of venous distension (swollen veins) is also observed.
- An abdominal examination may also be conducted which includes inspection, palpation, percussion and auscultation of the abdomen.
The above examination will allow your doctor to confirm or exclude the more serious or life threatening causes of chest pain. Further system-specific examination(s) may be conducted if necessary or your doctor will request a series of tests to confirm the diagnosis.