Document Detail

Management of acute chest pain syndrome.
MedLine Citation:
PMID:  2670088     Owner:  NLM     Status:  MEDLINE    
In differentiating the various etiologies of acute chest pain syndromes, the clinician is faced with identifying life-threatening situations. This article has presented a diagnostic approach for establishing the cardiovascular and noncardiovascular etiologies of acute chest pain syndromes. Cardiovascular etiologies must be identified early upon presentation in order to minimize morbidity and mortality. Myocardial ischemia and particularly necrosis is time dependent: early intervention preserves myocardium, particularly when initiating thrombolytic therapy. Aortic valvular disease, particularly critical aortic stenosis, if unrecognized, can precipitate rapid patient deterioration if inappropriately treated with nitrate therapy for presumed ischemic disease. Aortic dissection, if not properly diagnosed, can progress to stroke, MI, paralysis, and death. Noncardiovascular etiologies are similarly complex but often have less potential for life-threatening consequences. In identifying gastrointestinal bleeding, a careful rectal exam may be safely performed even in the setting of MI. A tension pneumothorax can suddenly compromise vascular return and progress to sudden death if unrecognized. Finally, chest wall symptoms, though seldom life-threatening, can be debilitating to the patient and often respond to anti-inflammatory therapy. In conclusion, the goals of this article were to present a step-wise approach to the diagnosis and management of an often complex presentation. By systematically approaching these patients with a thorough understanding of etiologies, diagnostic options, and therapeutic considerations, both physician anxiety as well as patient complications will be greatly diminished.
C E Chambers; D M Leaman
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Critical care clinics     Volume:  5     ISSN:  0749-0704     ISO Abbreviation:  Crit Care Clin     Publication Date:  1989 Jul 
Date Detail:
Created Date:  1989-09-29     Completed Date:  1989-09-29     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8507720     Medline TA:  Crit Care Clin     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  415-34     Citation Subset:  IM    
Division of Cardiology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey.
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MeSH Terms
Angina Pectoris / diagnosis,  etiology,  therapy*
Chest Pain / diagnosis,  etiology,  therapy*
Diagnosis, Differential

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