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Chest Pain in Women
|How Is Chest Pain Diagnosed?
The process for diagnosing the causes of chest pain is somewhat determined by whether the patient presents as an emergency situation in hospital (for example displaying signs of a heart attack) or whether they present in a non-emergency situation (for example when visiting their family doctor with complaints of occasional but persistent pain). In an emergency department the first and most important task for doctors is to rule out the most dangerous possible causes of symptoms of chest pain including heart attack, pulmonary embolism (blood clot in the lungs) and thoracic aortic dissection (a tear in the aorta blood vessel which causes severe and sudden chest pain). If all serious causes are ruled out the patient will be reassured. Further diagnostic tests can then be ordered at a later date to investigate the cause further. In a non-emergency situation a doctor will rely on a thorough physical examination and taking the patient's medical history. Depending on the outcome, further testing with a specialist may be recommended such as an electrocardiogram (ECG/EKG), exercise stress test, chest X-Ray and blood tests. Chest pain clinics usually offer the best service in this area.
What Can My Doctor Do?
If you are worried about persistent chest pain then do arrange an appointment with your doctor - unless of course you are experiencing heart attack signs which require immediate emergency care. A doctor can offer what is termed primary care - that is, health services which are available in the local community. He will carry out an extensive physical and medical history. Depending on the outcome of this he will either treat the patient personally or refer them onto a specialist such as a cardiologist for specific diagnostic tests or treatments.
The doctor will take a full medical history and will enquire if the patient has:
1. Had a previous heart attack.
2. A history of angina attacks. (Chest pain related to blocked arteries, coronary heart disease).
3. Any cardiac surgery such as heart angioplasty or bypass surgery.
4. Do they know their cholesterol level and when was it last measured?
5. Did they have any heart problems as a child or have they ever had rheumatic fever? (see types of arthritis for explanation).
6. Do they suffer from high blood pressure (hypertension)?
7. Do they have or is there a close family history of diabetes mellitus, congenital heart disease or early deaths in the family before 60?
8. Are they taking any drugs or anti-inflammatory medications?
In order to assess a person's risk factors for heart disease, the doctor will ask about their lifestyle. Specifically:
1. What do they weigh and have they experienced any sudden weight gain? Obesity is a risk factor and any sudden weight gain can indicate fluid retention associated with congestive heart failure.
2. Do they smoke?
3. Do they consider their diet healthy or unhealthy?
4. How much alcohol or caffeine do they drink?
5. How often do they exercise and for how long?
6. Is there any exercise they cannot do because of symptoms? For example, can they walk up the stairs without chest pain or breathlessness occurring? This is typical sign of angina.
7. What are their stress levels - at home and at work?
8. Have they completed menopause?
The physical examination should be extensive and include investigation in the following areas:
1. Does the patient look ill, do they appear short of breath, have they any difficulties talking. Are they obese?
2. Are there any signs of sweatiness, jaundice, paleness, clammy hands or xanthelasma (image, yellow patches which indicate a heart attack may occur) around the eyes?
3. Any sign of cyanosis (image)? This is where the skin turns blue due to lack of oxygen supply (oxygen is carried around the body by the blood). Most commonly seen in the fingernails, toenails, lips, ears, nose and cheeks.
4. Are the cheeks flushed? Also known as malar flush, it is a sign of mitral stenosis (a heart valve disorder).
The Pulse And Blood Pressure
1. The doctor will take your pulse. A pulse rate between 60 and 100 is considered normal in an adult.
2. The doctor will look out for signs of a quickening or slow pace as well as 'skipped' beats (a sign of heart arrhythmia).
3. He may also take your pulse in different parts of the body (the ankles for example) to monitor blood flow to the limbs.
4. Blood pressure is monitored in both arms; this is because a difference between the two can indicate a problem such as aortic dissection.
The chest will be examined and you will be asked to breathe in and out to check the lungs are working properly. The doctor may also place his hand flat on the heart to check for heart murmurs.
He will examine the abdomen for signs of any swelling in the aorta which could indicate a blockage (aneurysm). The aorta is the largest blood vessel in the body which extends down from the heart into the abdomen.
What If He Discovers A Problem?
It depends on what the problem is. If it is cardiac related you will be referred to a cardiologist for specialist heart disease tests. Possible tests include:
Exercise Stress Test
Chemical Stress Test
Nuclear Stress Test
If the doctor does not think it is related to the heart but rather, for example, a gastroesophageal disorder such as ulcers, acid reflux, or esophageal perforation, then you may be referred to gastroenterologist for a different set of tests. Other causes such as muscle or bone injuries may be treated by the primary care doctor.
What Happens In Emergency?
Hundreds of thousands of patients arrive in emergency departments across the United States every year with complaints of sudden and severe chest pain. 200,000 of those patients will turn out not to have heart related problems. 42 percent of those 200,000 will end up being diagnosed with a gastroesophageal disorder while a further 28 percent will have musculoskeletal problems such a muscle strain or rib fractures. However, when a patient arrives in hospital complaining of chest pain the doctor’s most important task is to first rule out immediately life-threatening heart problems. If a stroke or a heart attack has occurred, time is critical, the sooner it is diagnosed the sooner it can be treated and the more likely the patient is to survive.
1.The patient will be initially monitored for signs of confusion, breathlessness, pain, distress, paleness, vomiting or sweating.
2.Their vital signs including blood pressure will be taken.
3. A full physical examination, as explained above will be carried out.
4. An ECG will be performed to monitor heart activity and possibly a chest X-ray will be taken.
5. A blood test may be taken to measure cardiac enzymes; these are proteins which are released into the blood when there has been damage to the heart muscle.
6. If a heart attack is diagnosed, thrombolytic therapy will be given or if the hospital has suitable facilities a coronary angioplasty may be considered. See also: Treatment for Heart attacks and stroke treatment options.
If a life threatening problem has been ruled out the doctors will make what is called a presumptive diagnosis. That means they will say, the probable cause of your chest pain is X or Y. They will then refer you to your primary care doctor for follow up evaluation, referral or treatment. Next see: Treatment for chest pain.