WHY DOES MY CHEST HURT?

CHEST PAIN

 Discomfort in the chest including a dull ache, a crushing or burning feeling, a sharp stabbing pain and pain that radiates to the neck or shoulder.
Image result for chest pain

Diagnosing the cause of chest pain is often difficult. A careful history is often more useful then test:
  • Exercise induced central chest pain is usually cardiac in origin.
  • Rest pain might be: Cardiac, Pleuritic, Musculoskeletal, Nerve root irritation, Oesophageal, Mediastinal or referred pain of abdomen.
  • Lung diseases only cause pain if the pleura, mediastinum, intercostal nerve or bone is involve.
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IS IT CARDIAC PAIN? 
Central chest pain: radiates to arm and neck.Dull ache,severe heavy constricting character.May be associated with breathlessness.
Typical angina
Occurs on exercise and is eased by rest.
Acute coronary syndrome
Pain at rest or on minimal exertion, sometimes very severe with sweating pain persists.
Pericarditis
Dull or sharp, central, eased by sitting forward, may be worse with breathing.
Aortic dissection
Severe sudden onset, might be described as tearing pain in the back or anterior chest; patient often shocked.

IS IT PLEURISY?
Sharp pain in the side of chest, which catches with breathing. This is often accompanied by fever, cough with sputum or haemoptysis, indicating underlying lungs disease:
  • Pneumonia and pleurisy
  • Pulmonary infarction
  • Pneumothorax
Read-https://www.webmd.com/pain-management/guide/whats-causing-my-chest-pain#1
Image result for chest pain due to pleurisy

IS IT MUSCULOSKELETAL?
  • Trauma: Ribs fracture, Crushed vertebra
  • Chronic pain: Osteoarthritis, Ribs and bone disease
  • Muscles: Bornholm"s disease. Follows an upper respiratory tract infection.
  • Costochondral junction: Tietze"s disease, Responds of NSAIDs

IS IT NERVES ROOT IRRITATION?
  • Typically in a dermatome distribution around the chest. Might be unilateral.
  • Vertebral OA, Osteomyelitis, Prolapsed disc.
  • Melignant nerve root compression.
  • Herpes zoster (shingles)
IS IT OESOPHAGEAL?
  • Reflex cause retrosternal burning pain, usually after food. Worse lying flat and eased by antacid. Can be severe and mimic myocardial infraction.

IS IT REFERRED PAIN OUTSIDE THE CHEST?
  • Acute cholecystitis
  • Acute duodenal ulceration
  • Subphrenic abscess
  • Perforated bowel
  • Peritonitis
  • Pancreatitis.
WHAT TEST DO YOU NEED TO DO FOR CHEST PAIN
After a good history and examination do-

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