Chest Pain (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Chest pain facts
- Chest pain introduction
- What are the sources of chest pain?
- What are the causes of chest pain?
- How is chest pain diagnosed?
- What is the philosophy of the approach to chest pain diagnosis?
- What is the diagnosis and treatment for chest pain?
- Broken or bruised ribs
- Pleuritis or pleurisy
- Pulmonary embolism
- Angina and heart attack (myocardial infarction)
- Aorta and aortic dissection
- Esophagus and reflux esophagitis
- Referred abdominal pain
- Find a local Doctor in your town
The rash of shingles is caused by the varicella zoster virus, the same one that causes chickenpox. Once the virus enters the body, it hibernates in the nerve roots of the spinal column, only to emerge sometime in the future. The rash is diagnostic as it follows the nerve root as it leaves the back, and circles to the front of the chest, but never crosses the midline.
Once the rash appears, the diagnosis is relatively easy for the health care professional. Unfortunately, the pain of shingles may begin a few days before the rash emerges and can be confusing to both patient and health care professional, since the pain and burning may seem out of proportion to the findings on physical examination.
The treatment for shingles includes antiviral medications like acyclovir (Zovirax) along with pain control medication. Since it is the nerve that has become inflamed, the pain can be quite severe. Some patients may develop postherpetic neuralgia, or chronic pain from the inflamed nerve, which may persist long after the infection has cleared. A variety of pain control strategies are available from medication to pain stimulators to surgery. For more, please read the Shingles article.
An infection of the lung is called pneumonia, in which inflammation can cause fluid buildup within a segment of the lung tissue, decreasing its ability to transfer oxygen from air to the bloodstream.
Pneumonia presents with the typical symptoms of an infection:
- chills, and
There may also be:
The chest pain is pleuritic, hurting when taking a deep breath.
The classic presentation of a lung infection caused by the bacteria Streptococcal pneumoniae or pneumococcus, one of the most common causes of pneumonia, is acute onset of shaking chills, fever, and a cough that produces rusty brown sputum.
Physical examination may find the patient to have abnormal vital signs consistent with an infection. The pulse rate and respiratory rate may be elevated. A fever may be present. Listening to the chest may reveal decreased air entry in the area of the infection associated with crackles and occasionally wheezing because of inflammation and narrowing of the bronchial tubes.
A chest X-ray helps make the diagnosis, though the X-ray image sometimes lags behind the clinical findings by a day or two. Blood tests may be used to assess the severity of illness and may include a white blood cell count (markedly elevated or abnormally low counts may indicate more severe illness). Oxygen saturation measured with a probe attached to the finger is a way of assessing oxygenation of the blood and is routinely performed on patients with chest pain or shortness of breath. An arterial blood gas can exactly measure the amount of oxygen and carbon dioxide in the bloodstream to help determine the level of lung function.
Pneumonia may be caused by viruses or bacteria. The latter are treated with antibiotics, either by mouth or in the hospital by intravenous infusion. The general health and past medical history of the patient may guide the decision as to whether inpatient or outpatient therapy is most appropriate. For more, please read the Pneumonia article.
Next: Pulmonary embolism
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