It should be noted that the degree of chest pain is different, because everyone's tolerance to pain (also called pain threshold) is different, and it is not completely consistent with the severity of the disease.
Let's first look at the causes of chest pain.
1. Chest wall diseases. Acute dermatitis, subcutaneous cellulitis, herpes zoster and rib fracture can all cause chest pain. Among them, if the rib fracture pierces the pleura and causes pneumothorax, it needs urgent treatment, otherwise it will be life-threatening.
2. Cardiovascular diseases. Such as angina pectoris, myocardial infarction, acute pericarditis, thoracic aortic aneurysm, dissecting aneurysm and pulmonary embolism (infarction). In fact, this disease is the most common and the most critical and fatal disease in the emergency chest pain center. Take myocardial infarction as an example. If you have a myocardial infarction and have severe chest pain, we will still queue up for examination as a routine disease when you arrive at the hospital. These patients with chest pain will not be given priority. Then it is possible that the patient's examination has not been completed, the heart blood vessels have been completely blocked, and the heart has stopped beating.
Therefore, patients with chest pain like this must take the green channel when going to the hospital, and must give priority, because this is a race with death! The patient lives if he wins, and dies if he loses.
3. Respiratory diseases. Such as pleurisy, pleural tumor, spontaneous pneumothorax, bronchitis and lung cancer. Chest pain caused by respiratory system is generally caused by its pathological changes involving pleura and pulling it to pleura. This disease is relatively safe, and there is no danger of myocardial infarction and aortic dissection. Finding the cause can alleviate it.
4. Mediastinal diseases. Such as mediastinitis, mediastinal emphysema and mediastinal tumor. It is rare in clinic.
5. others. Other diseases such as esophageal cancer, subphrenic abscess and liver abscess can also cause chest pain, but it is still relatively rare.
So if you have chest pain, how do you judge what kind of disease it is?
Look at the age first. If you are over 40 years old, you should pay great attention to angina pectoris, myocardial infarction and lung cancer. Pay attention to spontaneous pneumothorax and tuberculous pleurisy when you are young.
Second, look at chest pain. For example, chest wall diseases are generally fixed and local, angina pectoris and myocardial infarction are mostly behind the sternum or precordial area, under xiphoid process, and aortic dissection is mostly behind the chest.
Third, look at the nature of chest pain. Herpes zoster is like cutting or burning. Angina pectoris is a feeling of strangulation, while myocardial infarction is a feeling as painful as death. Pulmonary infarction can also have severe pain, often accompanied by dyspnea and cyanosis of the lips.
Fourth, look at the time of chest pain. Angina usually lasts for a few minutes, while myocardial infarction can last for a long time, usually more than half an hour, and it is not relieved.
Fifth, look at the factors that affect chest pain. For example, angina pectoris is often caused by fatigue, cold and mental stress. It can be relieved after containing nitroglycerin, but myocardial infarction cannot be relieved. Esophagitis is generally aggravated after eating, and pleurisy and pericarditis are aggravated when coughing or dyspnea occurs.
Finally, let's see how the doctor handled your chest pain after you arrived at the hospital.
I'm Dr. Xiaoying. Now many hospitals know that there is a special department called chest pain center, and patients with chest pain can get priority treatment. The same is true for imaging department, and those with chest pain symptoms will also be given priority.
Why are these patients with chest pain given priority?
Chest pain is a symptom, not a disease. It is manifested as chest pain, and many diseases can be manifested as chest pain. If the patient walks into the hospital, tell the doctor that he has chest pain. The doctor will definitely be alert and will definitely ask in detail where it hurts, how it hurts, the duration and so on. Why are you so nervous? Because some diseases manifested as chest pain may die at any time, time is life. Such as acute myocardial infarction, aortic dissection, ruptured aortic aneurysm, pulmonary embolism and massive pneumothorax.
1. Acute myocardial infarction
Ischemic necrosis of myocardial cells caused by coronary artery embolism is a typical symptom of precordial pain, which can radiate to neck, arm, chest and back. The doctor will do ECG and myocardial enzyme examination. This disease needs to be diagnosed in time, and the blocked artery should be opened as soon as possible to restore the blood of myocardium, so time is life.
2. Aortic dissection and aortic aneurysm rupture
Both diseases are very serious. Aorta is the largest and thickest blood vessel in human body. Once torn or ruptured, the heart keeps pumping blood, and the mortality rate is very high. These two diseases can also be manifested as chest pain, tearing pain and blood pressure drop. CTA is necessary to make a definite diagnosis. If the doctor suspects aortic dissection or aortic aneurysm rupture, he can give priority to the imaging examination and report it within half an hour. If there is dissection or aneurysm rupture, he needs to call the billing doctor in time, so that the doctor can make a treatment plan as soon as possible to buy time for the patient.
This is a 38-year-old courier who suffered from chest pain, aortic dissection, total aortic tear and pericardial effusion after lifting heavy objects. I didn't go to see a doctor until my chest ached for two days, but there was nothing I could do.
3. Pulmonary embolism
It will be manifested as chest pain, shortness of breath, dyspnea and hemoptysis. If you suspect this disease, you can give priority to the examination in imaging department, and you also need to pass CTA examination to make a diagnosis. If it is found to be positive, it is also necessary to inform the attending doctor in time. Working the night shift tonight, I met two patients with pulmonary embolism.
4. A lot of pneumothorax
Compression of lung tissue, resulting in difficulty breathing. Sudden chest pain, dyspnea, suspected pneumothorax, need to do chest X-ray examination. When there is a lot of pneumothorax, a drainage tube should be placed immediately to exhaust the gas. Otherwise, the compressed lung tissue will die and stick together, thus losing its function.
There are many diseases showing chest pain.
These are the most serious diseases of chest pain, which is also the reason why many large hospitals set up chest pain centers. Of course, there are many diseases that can also manifest as chest pain, but they are not immediately life-threatening.
For example, respiratory diseases include pneumonia, tuberculosis, lung cancer, pleurisy and so on. Can cause chest pain. None of this is immediately life-threatening.
And musculoskeletal diseases. Chest pain caused by muscles or bones can be manifested as muscle swelling pain. If there is trauma, the cause of chest pain may be broken ribs.
Intercostal neuralgia can also manifest as lightning-like chest pain.
If you have chest pain, you must call the doctor immediately 120. If you can go to the hospital, you can go to the chest pain center or emergency department, and the doctor will judge what disease causes chest pain.
What disease is chest pain? Why do you always see "patients with chest pain first" when you go to the hospital now? Why?
Strictly speaking, chest pain is not a disease, but a "symptom". Many diseases can have symptoms of chest pain, but if the patient only has symptoms of chest pain, it can't explain what kind of disease it is, and it needs to be combined with clinic to improve the examination. Then, why does the hospital always have the prompt that "patients with chest pain are preferred"? Mainly because three of the diseases that chest pain may involve are very critical, and patients may die suddenly at any time. This is why the hospital should remind "patients with chest pain are preferred"! So, which three diseases are related to chest pain?
1, acute myocardial infarction
Most patients with acute myocardial infarction will have symptoms of chest pain, which is one of the most common and terrible diseases. For patients with acute myocardial infarction, time is myocardium and time is life! Therefore, general hospitals will open green channels for patients with acute myocardial infarction, with the aim of allowing such patients to get treatment as soon as possible and reducing the chances of death and disability.
2. Pulmonary embolism
For patients with pulmonary embolism, it can also be manifested as chest pain symptoms, and even some data show that the probability of chest pain in patients with pulmonary embolism is about 70%. Most of them are pleural chest pain, which is related to breathing and aggravated when coughing. It is generally caused by thromboembolism and peripheral arteries involving the pleura. Of course, some serious cases may also be caused by right ventricular ischemia due to large embolic area. It is especially suggested that pulmonary embolism is also a fatal disease, which must be paid attention to and treated in time without delay.
3. Aortic dissection
Aortic dissection will have chest pain, and compared with the above two diseases, aortic dissection is not bad at all, it can be said that it is even worse. About 90% aortic dissection is accompanied by chest pain, but this kind of chest pain is often accompanied by abdominal and back pain, such as knife cutting or tearing. Once found, it must be treated in time, and every minute counts.
The above three diseases will be accompanied by chest pain in many cases, and patients with these three diseases may die at any time, so there is a general reminder that patients with chest pain will be given priority in hospitals.
Chest pain is not a disease, it is a symptom!
Patients with chest pain are not necessarily dangerous, but some patients with chest pain are very dangerous. The reason why "chest pain takes precedence" is that chest pain may indicate a variety of fatal diseases. For these patients, time is life. Other patients may not have an accident if they delay for a minute or two, but some patients with chest pain may delay for a minute or two, which is probably the difference between life and death.
What are these severe chest pains?
1, acute myocardial infarction
As one of the clinical manifestations of coronary heart disease during myocardial infarction, patients are often accompanied by high-risk factors such as hypertension, hyperlipidemia, diabetes, obesity, smoking and metabolic disorder. According to the statistics of chest pain in Beijing in 2009, patients with acute myocardial infarction accounted for 27.4% of the chest pain population.
2. Acute pulmonary embolism
The most important risk factor is chronic cardiopulmonary disease, and patients are often accompanied by diseases such as left ventricle, pulmonary origin and pulmonary vessels. According to the statistics of chest pain in Beijing in 2009, patients with acute pulmonary embolism accounted for 0.2% of the chest pain population.
3. Acute aortic dissection
This kind of patients often appear because of the mutual promotion of aortic membrane structure abnormality and hemodynamic abnormality, and patients are often accompanied by diseases such as hypertension and connective tissue abnormality. According to the statistics of chest pain in Beijing in 2009, patients with acute myocardial infarction accounted for 0. 1% of the chest pain population.
Chest pain should not only be treated first, but also be treated first and then paid first aid!
In critical chest pain, the most typical is myocardial infarction. The attack of myocardial infarction is unexpected, and because it is similar to angina pectoris, but more intense, it is easy to delay the time. Therefore, it is suggested that patients with chest pain should call 120 in time once they have an attack.
120 emergency telephone not only does not waste time, but also can open a green channel in advance, saving time for the first aid of patients with myocardial infarction, and most hospitals in China have regulations for patients who need immediate rescue; "First rescue and then pay, life comes first", so please call 120 immediately in case of sudden chest pain, regardless of the cost. Even if I know that I can't afford medical expenses, I will save my life first, and then talk about other things, so that I can have hope of living.
At present, most emergency departments in hospitals have chest pain centers, and all emergency departments in hospitals will have eye-catching brand reminders, and those with chest pain are preferred. Many people may not understand what chest pain is, and why patients with chest pain will give priority to and open green channels in hospital emergency.
In fact, chest pain is only a symptom of many diseases, and there are many diseases that cause chest pain. However, several diseases are more dangerous, with rapid onset and rapid progress, threatening life. Therefore, the hospital emergency department attaches great importance to these patients. Before the diagnosis, all patients with chest pain can open a green channel, give priority to medical treatment and get the test results. Patients with highly suspected emergency need to enter the emergency room for monitoring and be ready for further rescue treatment at any time.
Common and serious diseases that cause chest pain are
1. Unstable angina pectoris and myocardial infarction are now commonly known as acute coronary syndrome, which is characterized by sudden and increasing retrosternal pain and chest tightness. Typical symptoms will be squeezing, accompanied by fear or feeling of dying, and radiate to the left shoulder and back. During the attack, there were nausea, vomiting and cold sweat, and some patients felt difficulty breathing. Acute coronary syndrome is more acute, and the incidence of hypertension, diabetes, obesity and long-term smoking is higher in middle-aged and elderly people. If you have nitroglycerin on hand, you can give up first aid.
2. Aortic dissection is nicknamed "cyclone bomb" in clinic, which brings great danger to people. The most common symptom of aortic dissection is sudden and severe pain in the chest and back, which is knife-shaped and generally radiates from the chest to the chest or back. This kind of pain lasts for a long time, and nitroglycerin can't relieve this severe pain. Once the adventitia breaks and bleeds, it often dies of hemorrhagic shock in a few minutes, with a high mortality rate. If acute aortic dissection is suspected, CT angiography, MRI and color Doppler echocardiography of aorta should be completed as soon as possible to make a clear diagnosis.
3. Pulmonary embolism Pulmonary embolism is also a medical emergency. Pulmonary embolism is often misdiagnosed as myocardial infarction, which is as dangerous and fatal as myocardial infarction. It is characterized by sudden chest pain, dyspnea, hemoptysis, pallor, sweating, and even a sense of dying. Pulmonary embolism is the most dangerous within 24-72 hours of onset, and the high-risk groups include orthopedic patients, bedridden patients after pelvic surgery, patients with deep venous thrombosis of lower limbs, patients with atrial fibrillation, and long-term oral contraceptives.
4. Pneumothorax Spontaneous pneumothorax also manifests as sudden chest pain or dyspnea. The diagnosis of pneumothorax is relatively simple, and the diagnosis can be made by taking a chest X-ray directly. Spontaneous pneumothorax usually occurs in lanky people, especially young people. Often found suddenly when coughing violently, exercising vigorously and lifting heavy objects.
Because these chest pain diseases develop rapidly and may be life-threatening, they are usually given priority in emergency. Early chest pain center is to reduce the incidence and mortality of acute myocardial infarction. Nowadays, the chest pain center has gone far beyond the treatment scope of acute myocardial infarction. Through the cooperation of pre-hospital emergency system (EMS) with different levels of hospitals and multi-disciplinary departments (including emergency department, imaging department, laboratory department, cardiology department, thoracic surgery department, digestive department, respiratory department and other related professional departments), it has developed into a regional collaborative treatment system to provide rapid and accurate treatment for all kinds of patients with acute chest pain.
Chest pain is a very common clinical symptom. Acute chest pain accounts for 5% ~ 20% of medical emergencies in small and medium-sized hospitals, and 20% ~ 30% in tertiary hospitals.
Risk stratification of acute chest pain
According to the severity of prognosis, chest pain can be divided into high risk chest pain and low risk chest pain.
Low-risk chest pain: reflux esophagitis, costal chondritis, herpes zoster, pleurisy, cardiac neurosis, etc. Good prognosis, generally not life-threatening;
High-risk chest pain: including acute myocardial infarction, aortic dissection, acute pulmonary embolism, tension pneumothorax and esophageal rupture. The prognosis is poor and the risk of death is high.
Significance of chest pain center
The prevention and treatment of cardiovascular diseases is an important link in the implementation of the "Healthy China 2030" plan.
20 1 7165438+1October1,the General Office of the National Health and Family Planning Commission issued the Guiding Principles for the Construction and Management of Chest Pain Centers (for Trial Implementation) (hereinafter referred to as the Principles), announcing that hospitals above the second level should do a good job in the construction and management of chest pain centers.
The purpose is:
Chest pain first
There are many causes of chest pain, and the most dangerous ones are myocardial infarction and aortic dissection. Therefore, patients with chest pain should first rule out this situation, so that patients with myocardial infarction can be found and treated in time. These can be fatal in a few minutes, so we should wear chest pain signs so that patients can register, see a doctor, complete the examination and go to the operating table as soon as possible. Also remind medical workers that this patient has chest pain and should be taken seriously.
Some hospitals will set up special chest pain centers, and also set up green channels for chest pain in hospitals, drawing lines on the ground to guide patients with chest pain to reach their destinations quickly. So the next time you see a patient with a chest pain sign in the hospital, take the initiative to make way.
Chest pain is not a disease, but a common manifestation of several diseases. Because of chest pain, several diseases are very serious and need urgent treatment, that is, the kind that needs to be dealt with against time, that is, the kind of disease in TV series that "the patient will die if he comes a few minutes late." Such as myocardial infarction, such as pulmonary infarction, such as aortic dissection and so on. , are deadly diseases every minute.
Therefore, the hospital should set up a priority green channel for patients with chest pain, so that these patients can waste less time in queuing for registration, queuing for medical treatment and queuing for examination. Thereby saving time and allowing patients to directly enter the treatment. This can increase the success rate of first aid for patients.
Chest pain always happens in our life. Let me tell you the difference between fatal chest pain and chest pain caused by other diseases.
1. Chest pain caused by angina pectoris and myocardial infarction
This is terrible chest pain. Sudden pain in the patient's left chest can also hurt shoulders and arms, fingertips and teeth. The patient was sweating profusely and was afraid of death.
2. Pulmonary infarction
Pulmonary infarction is also a fatal disease, and patients will have chest pain, dyspnea, hemoptysis and other symptoms.
3. Aortic dissection
Sudden and severe pain in the chest, back and abdomen, like a knife cut. This is because the blood in the arterial cavity enters the aortic media from the tear of the aortic intima. Mainly occurs in middle-aged and elderly people with hypertension. If middle-aged and elderly people have high blood pressure, if there is sudden pain in the chest and back, then you must be careful.
4. pneumothorax
Pneumothorax can also cause chest pain, similar to tearing pain, often accompanied by dyspnea, and the pain is aggravated when coughing. Spontaneous pneumothorax is mainly seen in tall and thin people.
5. Herpes zoster
Chest pain, mainly skin surface pain, herpes, mainly on one side.
6. Esophageal diseases
Burning pain behind sternum.
The first three diseases are fatal in minutes and need to be rescued in time. Therefore, hospitals should set up a green channel for chest pain.
Most hospitals have signs of "chest pain first". People who don't know will wonder, "Why can chest pain be given priority and low back and leg pain not?" Because chest pain is likely to be life-threatening!
The priority of chest pain is actually related to the cause of chest pain.
Such as myocardial infarction, aortic dissection, pulmonary embolism and pneumothorax. These are all urgent diseases, and the earlier you treat them, the more hopeful you are for survival. This is the law of "giving priority to chest pain".
(1) Take the most common disease: myocardial infarction as an example. Myocardial infarction has a time for rescue and thrombolysis, that is, effective first-aid measures can be taken in the shortest time to minimize the damage.
I have been in a similar situation before. The patient felt chest pain, came to check, and hung up an ECG directly without consulting a doctor. Something was wrong with the electrocardiograph, so he immediately found a wheelchair to push the patient to the emergency room. At that time, the patient was still puzzled. I can walk well. Why did I find a wheelchair? Later, I heard from the doctor in the emergency room that it was indeed a myocardial infarction, and it would be dangerous to be an hour later.
Generally, within two hours, the damaged area of myocardium is small, with chest pain as the main performance. If it is not effectively controlled at this time, the area of myocardial infarction will increase, which is in danger of shock and even death. Generally, if the damaged area of myocardium reaches 50% within six hours, it is likely to lead to heart failure and death.
(2) In addition, like aortic dissection, the symptoms of chest pain are more obvious. The human body's largest artery is dissected and torn, and its pain is unimaginable. Conditional hospitals can operate in the shortest time, otherwise patients are likely to lose their precious lives in a short time.
Therefore, in order to reduce the death rate of myocardial infarction, aortic dissection and other diseases as much as possible and gain more time for the first aid of these diseases, the hospital has formulated this regulation.
Therefore, if you have unexplained severe chest pain, you must arrive at the hospital immediately accompanied by your family. In the meantime, keep your mood stable and don't do strenuous exercise.
Now many hospitals have "chest pain centers", and all patients with chest pain will receive priority treatment. As a patient, Dr. Wu also experienced it once: two years ago, when Dr. Wu was exercising, he suddenly had chest pain, especially when inhaling, and he almost dared not breathe. No choice but to call a friend and send him to the emergency department attached to the gymnasium of the Municipal People's Hospital, so Dr. Wu was able to experience a "chest pain patient first" as a patient. When the attending doctor learned that I had chest pain, he immediately measured my vital signs and made a preliminary physical examination. At the same time, he arranged an ECG examination for me and completed the ECG and physical examination for me within 5 minutes of entering the door. At the same time, the nurse also inhaled oxygen for me at the first time, opened the venous access and completed blood tests such as blood gas and myocardial enzymes. There is no half-minute delay in the whole process.
What is so special about chest pain? Why do patients with chest pain need priority?
In fact, chest pain is a very dangerous symptom. In some cases, if the delay is one minute, the patient's life will be at greater risk. In order to save the lives of more patients with chest pain, "chest pain center" came into being, which is why many hospitals have "chest pain patients first".
So, what are the life-threatening situations of chest pain? 1. Acute myocardial infarction
The heart is equivalent to a person's "engine". The heart is responsible for delivering blood to all organs of the body. If the heart strikes, people will die suddenly. Acute myocardial infarction is one of the more dangerous heart diseases. Myocardial infarction is a kind of heart disease mainly caused by coronary artery occlusion and myocardial ischemia, which is very dangerous. Every minute the patient delays, his life will be tested for one more minute. The best way to save is to make a definite diagnosis at the first time and restore coronary perfusion at the first time. This is also the reason why patients with chest pain need to check ECG and draw blood to check myocardial enzymes at the first time!
2. Aortic dissection
Generally speaking, aortic dissection refers to the rupture of the vascular wall of the artery, and patients often show severe chest pain like tearing. This disease is also very dangerous. Once the aortic dissection is ruptured, even if Jesus comes, there is no good way, so it is also a disease that needs immediate treatment.
3. Pulmonary embolism
When it comes to pulmonary embolism, it refers to diseases caused by emboli (venous thrombosis, fat particles, etc.). ) falls off and flows into the pulmonary vessels with the blood flow, thus blocking the pulmonary artery. Patients may have chest pain, dyspnea and hemoptysis. This is also a very dangerous disease. If the pulmonary artery trunk is blocked, the patient will die suddenly at any time.
4. Tension pneumothorax
Pneumothorax refers to the disease caused by gas entering the pleural cavity, which makes the pressure in the thoracic cavity too high and oppresses the lungs. Tension pneumothorax is a more dangerous type. Tension pneumothorax is mainly due to the rupture of larger pulmonary bullae or larger and deeper lung laceration or bronchial rupture, which communicates with pleural cavity and forms a one-way valve. The pressure in the chest cavity is constantly increasing, and the lungs are constantly compressed and shrunk. The main symptoms of patients are chest pain and dyspnea, which is also a dangerous disease. If the rescue is not timely, the patient will soon be "suffocated" alive.
Of course, there are other relatively mild symptoms of chest pain, such as herpes zoster and intercostal neuritis, which generally do not endanger the life of patients. Chest pain may be "heavier than Mount Tai" or "lighter than a feather", but before the diagnosis, who can say whether chest pain is "heavier than Mount Tai" or "lighter than a feather"? In order to save more lives, chest pain should not be too concerned!
Chest pain is the most common symptom of cardiovascular disease, and it may also be one of the symptoms of critical cardiovascular disease. Therefore, when going to the hospital for examination, patients with chest pain will generally be given priority. The following are some of the most common fatal chest pain diseases.
In short, if you have chest pain, especially chest pain that cannot be relieved, you must go to the hospital in time. The first department to see a doctor can be considered as the emergency department. If there are corresponding conditions, the hospital can see the emergency cardiovascular department.