Cómo saber si un DOLOR EN EL PECHO es PREOCUPANTE. Síntomas relevantes en dolor torácico (Engl subs)
November 17, 2019
Helo, my name is Iago López I’m one of the family practitioners of Centro Médico Pontevedra and today we are going to make a video about
chest pain Those of you who are already subscribers to our channel, probably will remember that two months ago we had made a video about headaches and how to know its cause based on symptoms Today we’ll make the equivalent to that but, in this case based in another symptom which usually is a major cause of concern which are the causes of pain located in the chest region the region between abdomen and neck In order to correctly indentify a chest pain syndrome… … we should pay attention to some features that coexist with this pain The first thing we should pay attention to is… what type of pain/soreness it is if it is a stinging pain, like a knife or a needle is it’s an oppresive type of pain if the sensation resembles an electric shock, etc Timing is also critical which is the behaviour of this pain through time if it begins suddenly or progressively whether it lasts minutes, hours or days… if it disappeared spontaneously or after rest or any other action it is also very important to know if there is any respiratory distress And when we speak about respiratory distress… we are not talking about the subjective sensation of “lack of air” but the external show of that lack of respiration when a patient doesn’t breath properly because any obstructive cause breathing will happen at a fast pace because the reflex of the brainstem when oxygen levels go down causes us to breath much more rapidly and much more widely so you’ll see a hectic breathing in those who suffer real respiratory distress It is also important to know the area that is affected by the pain, and how broad it is. if we are talking about a point or a large area if the patient points to the pain with his index finger or with the palm of his hand that’s also a feature of this pain that do help a lot when trying to find out the cause And there are other accompanying symptoms that can also be important …like knowing if fever is also present or not…. …if the patient also shows profuse sweating… …If nauseae are also present… …if the person feels ill… That’s all because of the reasons we are going to describe next. so we are going to define, based on the type of pain, which would be the diagnostic algorythm … whichi would be the features on which we would need to pay attention to in order to try to find out the cause of the pain So, we are going to begin with the stinging pain as I said before, a stinging pain is that resembles something getting nailed or stabbed This kind of pain causes a lot of alarm, and with a good reason because even when it can be cause by banal causes, like wall pains… … it is also the type of pain that feels someone during a pulmonary embolism… … Or pneumonia, or pneumothorax So… In order to correctly define this pain … the first thing we ought do if we suffer this type of pain is to find out if the pain gets worse when pressing the area with finger pressure to find out if the pain gets more intense when touching or pressing If that is the case, then it’s good news, because we would be talking about something about thoracic wall (ribs and muscles) or even something outside the thorax, like pectoral muscles, mammary gland other regions that are outside the thoracic cavity In conclusion, if pain intensifies when touching or pressing, it’s good news it is true that some other diseases more important like rib fracture, also may have this sign But in that case there should be a previous trauma and furthermore, though solitary rib fractures are painful, very seldonly may cause any real threat. it only causes pain Another feature that we should take into account is… whether the pain goes along with rapid breathing as I was saying before, this can be better perceived by an external observer than the patient himself because there are some syndromes like anxiety, when the patient feels lack of respiration … but an external observer sees a normal pace when breathing So…. In a case of stinging pain… …that doesn’t get worse when touching or pressing… … if also the breathing happens at a fast pace… We should head INMEDIATLY to the E.R. because is there is fast respiration, it’s typical of a real respiratory distress and the chances of it being a pneumothorax, pneumonia or pulmonary embolism are high …. thus we should head without hesitation to the E.R. The timing is also important in this type of pain If we are in a case of a sudden pain, only in a few seconds… that is also highly sugestive of a grave disorder: both pulmonary embolism and pneumothorax usually happen suddenly so, if that is the case, we head inmediately to the ER and also, if there is not so much respiratory distress, but fever is present it would also require medical assistance, not so rapidly, but should be assisted in the same day but fever plus stinging pain, it suggests as the main cause, a pneumonia thus, this would also be deserving medical encounter Let’s go now to another important pain syndrome and which also could mean grave disorders which is oppressive pain that kind of pain in which the person feels like being strongly hugged or that is bearing a great burden in the chest a sensation that doesn’t allow him to breathe properly this kind of pain might be cause by a number of disorders, ando some of them not so important… … but also very critical ones It can be a heart pain. Angina and infarction may cause this type of pain as we had previously said in our video about heart attacks … but we should not forget that anxiety causes a pain that is almost identical to that of the heart attack and they resemble it so perfectly that it’s not uncommon to find a person with an axiety syndrome admitted at the cardiology service of a hospital because even the doctors mistook… the symtoms with those of a heart attack and there are also, although less frequently there are syndromes of esophageal pain which also may be oppresive most of all, the esophageal spasm can cause this type of pain So let’s follow the same scheme that we did with stinging pain: First of all: Timing If the oppresive pain happens suddenly, we should call the emergency services we are in front of a syndrome that might be a heart attack most of the heart attacks happen as a consequence of a platelet thrombus that has happend suddenly in a coronary artery that means that in a matter of seconds a coronary gets stuck and in a few minutes, that heart begins to ache because lack of irrigation so, sudden onset is a worrying symptom. It’s a reason to go to the ER if it happens progressively, we can think about other possibilities but sudden pain, requires emergency assistance second feature: respiratory pattern (breathing pace) in this case, this symptom is not so useful, because people suffering a heart attack … feels lack of breath, but doesn’t breath rapidly because normally, unless sudden heart failure happens, which is not so common t’s not usual to find real respiratory distress so in this case, seeing the patient breathing at a normal pace, is not necessarily a good sign because feeling false lack of breath is part of the normal heart attack syndrome so in this type of pain, paying attention to breathing is not that important and there is another symptoms to take into account: nauseae, vomits, or profuse sweating, skin paleness are very worrying symptoms. They are the usual behaviour of the vagus nerve… … during anginae or heart attacks So, if the patient is pale and sweaty, is also a reason to head to the E.R. if it goes along with a oppresive chest pain Let’s adress now another sensation that may be painful or not, which is… a sensation of internal heat in the thorax the sensation of heat, although is typically attached to gastroesophageal reflux…. … and we shouldn’t forget that gastroesophageal reflux happens in nearly half of the population… … so it’s a diagnose that always can be taken into account in the doctor’s and patient’s mind the truth is that heart attacks can also cause heat sensation so we have to remember this and for instance, in our video about heart attacks one of our viewers pointed out very well, in a moment where I defined wrongly this type of pain because I was referring to the skin sensation of burn she mentioned that, in her mother’s case, she had a heart attack and felt heat and it is true: the sensation of heat may also suggest a heart attack So in this case, we have to use our common sense: If there is a person who suffers from gastroesophageal reflux from years ago… and today feels a heat very similar to many other similar previous occasions well, in this case, the logical thing is to think that it’s just another case of reflux and nothing more but we should worry if some person, like a 60 year old woman that never has experience reflux … suddenly begins feeling that heat inside the chest Maybe it is the onset of her first reflux, but we can’t afford to leave that doubt this person that experiences this sensation and never before… … requires medical assistance at ER and in the case of women, we have more reasons to suspect, because, as it was said at the… video about heart attacks, symptoms in women can be more misleading less typical, less standard than that of a male patient so we must remain vigilant to these symptoms not so classic, when happen in a woman with some risk factors And now, the other symptom that I mentioned before: the sensation of burn in the skin that is a symptom that is nearly exclussive of nerve irrititation we have, in the thorax region, 12 pairs of intercostal nerves each of them running under the upper rib, and when they get sore for a number of causes might be because a little knock, an intercostal muscle, even an inflamation of a joint we’ll get a sensation that can be, among others, burning sensation at the skin but we must be careful, because another cause of nerve irritation is Herpes Zoster which usually isn’t grave, but it can be really painful, and treating it too late might lead to a… chronic neuralgia, which is a horrible pain, with high demands of pain killer and long duration So if we have this pain, it’s a good idea to look after it daily, in order to detect spots on the skin and it there are spots or skin vesicles, it’d be a good idea of going to the doctor because if it is the case of a Zoster, it will be a good idea to treat it Another type of pain is that of a sensation of ‘electric shock’ It has the same meaning as the burn sensation at the skin feeling electric shocks is a symptom nearly exclusive to nerve irritation when we hurt a nerve, is very common to feel electrick shock but it would be really extraordinary that a heart attack or pneumothorax or pleural disorder to… cause electrick shock sensations it’s nearly exclusive to nerves, for better or worse for worse, because as I said, that kind of pain may precede the spots or vesicles of Zoster so we have to check it daily in order to detect vesicles and head to the doctor in order to early treatment and avoid chronic neuralgia And then there’s another kind of pain, which books reffer to as ‘dull pain’ that is the kind of pain that everybody has experienced after a knock in a muscular area or the pain of an haematoma a pain in a coin-sized area, whose boundaries are not well defined this kind of pain is most commonly due to a muscular injury An injury at the pectoralis major or the dorsal muscle may cause dull pain even that mammary acini that aches in the previous days to the period in women can also cause dull pain however in this case we should apply the same protocol as in oppresive pain because in some cases, the heart may cause dull pain also so is not a bad idea to pay attention to the same features as in the oppresive pain and well, in this diagnostic algorythm it’s not so hard-and-fast as that in the video about headaches the video about headaches enables people to nearly diagnose the cause of their pain but chest pain is much more misleading and in many cases, tests like auscultation are mandatory in order to find the cause of the pain so chest pain is one of the reasons why doctors usually have a stethoscope around our neck it’s not only to have a more ‘doctor-like’ appearance and look more smart stethoscopes play a main role in the diagnose of chest pain however I do believe that this video might help you to somehow measure the severity of your illness and to know if you have to go more or less early to the doctor but it’s mostly useful when you go to the doctor, to bear in mind which are the symptoms that he’ll ask you because, this may seem obvious, but but many bad diagnoses are due to wrong communication between doctor and patient this means that some deaths happen because information has not been correctly transmited from the patient to the doctor, whether if the doctor din’d ask properly or the patient didn’t explain so going to the doctor knowing what to tell: what type, where, when, breathing, etc they are critical data for the doctor in order to correctly diagnose your illness so it can save lives. It the patient knows what to tell is very important for diagnosing and also, one of the main goals of this video, like most of the other we’ve previously shot is to make people know that the reasoning of the doctor is a logical and scientific one we do not study at a wizard ivory tower, at a secret library some arcane spell books everything we do is based upon scientfic knowledge and logical thinking and there is the problem that us, the doctors, usually don’t know how to convey this assertiveness to the patient. And that’s what makes sometimes the patient ending in the hands of some con man with great ease of speech which provide atractive, yet false, explanation to their disorders and that is the success of all that quacks: homeopathy, anti-vaxxers, useless polyvitaminics in people who don’t need vitamins… At the end, all the nonsenses to waste people’s money and wasting their money, time and hope when not directly harming the health of the patient so, making the doctors recover our intelectual assertiveness is pretty important so the patients pay attentions to our advice otherwise, we’ll keep seeing a progressive undermining of vaccination rates because of disinformation campaings main guilt of disinfo goes to disinformers, but it’s also the doctor’s responsability to provide useful and fact-based information about our patients disorders so they are able to see what is reasobable and what is absolute quackery and with this I say goodbye to you until our next video if you want to be aware of our videos you can subscribe by clicking here and if you like this video and think it’s useful to another people you can press the like button which allows it to be at the upper level (if you like the translation, please leave a comment and we’ll translate the rest of the videos). Bye!