What Are the Most common Causes of Chest Pain with Fever?

Cardiovascular doctors have strengthened their studies on the differential diagnosis of chest pain, especially to improve their understanding of noncardiac chest pain. Chest pain can be divided into two categories: cardiogenic chest pain and non-cardiogenic chest pain.

Cardiogenic chest pain

Classification and mechanism of cardiogenic chest pain

Cardiogenic chest pain Cardiogenic chest pain mainly includes:

(1) Coronary heart disease: angina pectoris, myocardial infarction

(2) Acute pericarditis

(3) Aortic dissection

(4) Other organic heart diseases: cardiomyopathy, myocarditis, heart valve disease, aortic aneurysm, aortic sinus tumor rupture, etc.

(5) Cardiac neurosis.

Cardiogenic chest pain mainly includes:

(1) Chest wall diseases: acute dermatitis, subcutaneous cellulitis, shingles, myositis, costal chondritis, intercostal neuritis, rib fractures, bone pain caused by blood system diseases (acute leukemia, multiple myeloma) Wait;

(2) Respiratory diseases: pulmonary embolism (pulmonary infarction), pleurisy, pleural tumor, spontaneous pneumothorax, acute tracheobronchiolitis, pneumonia, lung cancer, etc .;

(3) Mediastinal diseases: mediastinal abscess, mediastinal tumor, mediastinal emphysema;

(4) Digestive system diseases: Gastroesophageal reflux disease (GERD) includes reflux esophagitis, esophageal cancer, acute pancreatitis, gallbladder disease, esophageal spasm, hiatal hernia, etc.

(5) Psycho-mental diseases: such as depression, anxiety, panic disorder, etc.

(6) Others: such as hyperventilation syndrome, gout.

Cardiogenic chest pain

Various stimulating factors such as hypoxia, inflammation, changes in muscle tone, tumor infiltration, tissue necrosis, and physicochemical factors can stimulate the sensory nerve fibers in the chest, produce pain urges, and upload them to the pain center in the cerebral cortex, causing chest pain. Chest pain caused by non-chest visceral diseases is due to the presence of radiating pain or referred pain, because the afferent nerves of visceral lesions on the surface of the corresponding area enter the same stage of the spinal cord and are connected in the posterior horn. Visceral sensory impulses can directly stimulate sensory neurons on the surface of the spinal cord, causing pain in the corresponding body surface area.

Cardiogenic chest pain and its characteristics

Noncardiac Chest Pain (NCCP) and its characteristics

Noncardiac chest pain involves many diseases, and there are currently six major types of NCCP. The characteristics of these six diseases are as follows:

Cardiogenic chest pain chest wall disease

Most noncardiac chest pains originate from the chest wall and pleura. There are ribs, muscles, nerves, etc. on the chest wall. Pleural pain is related to breathing and cough. Chest pain becomes worse during deep breathing and cough, often accompanied by dyspnea. Chest pain is located on the side of the lesion. The typical manifestation is that deep breathing or cough makes it worse. Fixing the chest wall can be controlled. For example, the patient will press one side of the chest wall to avoid deep breathing or suppress cough. Patients can usually point out the pleural pain. After a period of time, chest pain may move from one location to another. If pleural effusion occurs, the pain disappears due to the partitioning of the inflamed pleura surface. Pleural friction sounds are often accompanied by pleural pain, but can also occur alone. Pleuritis is more common in domestic tuberculosis patients. Chest pain begins at the beginning of the disease, and cough and deep breathing are exacerbated. Chest pain disappears when there is more pleural effusion, which can be accompanied by fever, night sweats, weight loss, appetite and other symptoms. Thoracic or B ultrasound can be To diagnose, you need to pump fluids in time to prevent adhesions or packages. Follow your doctor's advice and insist on taking enough anti-tuberculosis medication. Cancerous pleural effusion can find cancer cells and anti-cancer treatment. Pain originating from the chest wall can also be exacerbated by deep breathing or coughing, but it can usually be identified by local tenderness. Although pleural pain may sometimes be tender (such as pneumococcal pneumonia) However, it is usually slight, the positioning is not clear, and only deep pressure can lead. Chest wall trauma or rib fractures often have a significant history, but a severe cough can also cause muscle fiber tears and even rib fractures. Tumors that invade the chest wall can cause local pain, such as involving intercostal nerves, which can cause involved pain. Herpes zoster can cause difficult-to-diagnose chest pain before it erupts. Costal chondritis is mostly located at the junction of the third and fourth ribs and costal cartilage. It is acupuncture-like or persistent acute pain, with slight bulging and tenderness seen locally. This disease is a non-bacterial inflammation. You don't need to take antibiotics, you can take antipyretic and analgesic drugs such as ibuprofen and fenpyridine. Neuritis caused by viruses, such as shingles or intercostal neuritis, or nerve root spurs caused by spinal or spinal disease. The pain area is mostly located in the intercostal nerve distribution area of the lesion, which is tingling, burning, or even knife-like pain, and the intercostal nerve at the lower edge of the rib may have tenderness. Neuritis caused by viruses, such as shingles or intercostal neuritis, or nerve root spurs caused by spinal or spinal disease. The pain area is mostly located in the intercostal nerve distribution area of the lesion, which is tingling, burning, or even knife-like pain, and the intercostal nerve at the lower edge of the rib may have tenderness. There are multiple herpes between the shingles between the ribs and can be fused into slices.

Cardiogenic chest pain respiratory disease

The lungs are wrapped by the pleura. If the pleura is inflamed, infected, or irritated, that is, when pleurisy occurs, the patient will experience the pleural pain mentioned above. Pain originating from other respiratory structures is usually less characteristic than pleural pain. Pulmonary abscesses, tuberculous cavities, or bullae can occasionally cause deep pulmonary cryptic pain. This cryptic pain can also occur when the pulmonary vasodilator is stimulated. Sudden unilateral chest pain, but also shortness of breath symptoms, may be pneumothorax, at this time auscultation can not hear breathing sounds on the pain side, chest X-rays, we can be sure the occurrence of pneumothorax. A rapidly growing mass in the lungs occasionally causes pain with unclear location, and physical examination and chest X-rays often identify the cause.

Spontaneous pneumothorax without trauma or human factors, the pleural effusion caused by the sudden rupture of lung tissue and visceral pleura, the male to female ratio is 5: 1, more common in young adults aged 20-30, often due to subpleural emphysema Caused by rupture, also found in subpleural lesions or hollow ruptures, tears of pleural adhesions. Subpleural emphysema can be congenital or secondary. The former is common in pneumonia. It is found in lean men with no obvious disease on chest X-ray examination. Swelling emphysema vesicles degenerate due to nutrition and circulatory disorders, and rupture when coughing or increased intrapulmonary pressure (such as sudden exertion, defecation or beating) Spray, etc., due to the violent action caused a sudden increase in the pressure in the trachea). There are three types: closed, open and tension. The typical symptoms of pneumothorax are sudden chest pain, followed by chest tightness or dyspnea, irritating cough, shortness of breath due to tension pneumothorax, suffocation, irritability, cyanosis, sweating, shock, etc. X-ray examination can confirm the diagnosis.

The causes of pulmonary embolism are clinical and pathological syndromes caused by pulmonary circulation disorders caused by clogging of the pulmonary artery or its branches with foreign thrombus. Pulmonary hemorrhage or necrosis is called pulmonary infarction. Thrombus mainly comes from deep vein thrombosis of the lower extremities; 51% -71% of patients with deep vein thrombosis of the lower extremities may develop pulmonary embolism. Lower extremity thrombophlebitis, varicose veins, atrial fibrillation with heart failure and thrombosis, long-term bedridden patients, pregnant women are all risk factors. Symptoms: There may be chest pain, shortness of breath, hemoptysis, dyspnea, cyanosis, syncope, sweating, and even sudden death. The symptoms are related to the size of the embolism area. It is recommended to go to the hospital for examination and treatment. Thrombolysis or related rescue when the heart is in need, the incidence of pulmonary embolism has increased significantly in recent years, and the misdiagnosis rate is also high. Vigilance should be increased.

Pneumonia A bacterial or viral infection with fever, cough, expectoration, chest pain, chest X-ray or chest radiograph can be diagnosed.

Lung cancer A tumor invasion of the chest wall can cause persistent and progressive chest pain. A chest radiograph or chest CT can confirm the diagnosis.

Cardiogenic chest pain mediastinal disease

The rapidly growing mass of the mediastinum occasionally causes pain with unclear location. Physical examination and chest X-rays can often determine the cause.

Cardiogenic Chest Pain Digestive System Disease

Gastroesophageal Reflux Disease (GERD), including occult GERD, refers to symptoms and tissue damage caused by reflux of gastric and duodenal secretions (gastric acid, pepsin, bile, pancreatic juice) into the esophagus. Mainly manifested as heartburn, pantothenic acid, and post-sternum burning sensation. Chest pain is located in the middle of the chest. Behind the sternum, it radiates to the shoulders and radiates to the inside of the upper arms. It occurs at night or in the morning, much like angina-like chest pain, mainly due to reflux. The esophageal mucosa is irritated, causing reflux esophageal inflammation and pain. GERD is very common in Western countries and is the most common cause of noncardiogenic chest pain [2-4], accounting for 44% of NCCP [5], and about 7-15% of the population has symptoms of gastroesophageal reflux, and the age of onset is increasing And the increase, 40-60 years of age is the peak age of onset, there is no difference between men and women, but there are more men than women in reflux esophagitis (2-3: 1). The prevalence of GERD in Beijing and Shanghai is 5.77%, and reflux esophagitis is 1.92%, which is lower than that of western countries and the disease is also mild.

Carcinoma of the esophagus ( Carcinoma of the esophagus), the incidence rate in northern China can reach 130 / 100,000, early esophageal cancer symptoms are usually atypical, the main symptoms are post-sternal discomfort, burning sensation, acupuncture-like or traction-like chest pain; Slow and lingering or mild tingling. In the middle and late stages of swallowing pain, especially after eating hot and acidic food, pain can appear in the chest, back, neck, scapula and other places, similar to angina. Oesophageal hiatal hernia , the pain of the disease is located behind the sternum, and is easy to occur when sitting or lying after a full meal. The pain is similar to angina, but it can be avoided by eating or standing or walking for half an hour after a meal. Fiber endoscopy or barium meal examination of the esophagus can help confirm the diagnosis.

- Cardiogenic chest pain psycho-psychiatric disorder

Psychocardiology [6,9] is an important field of psychosomatic medicine. It has been paid more and more attention in recent years. 20-30% of psychiatric patients have psychosocial disorders. Complaints of chest pain and chest discomfort without evidence of organic heart disease. Such as depression, anxiety, panic attacks, etc. [7] can be referred to the cardiology department for acute or chronic chest pain. Cardiac neurosis, which is more common in women, especially menopausal women. It manifests as chest tightness or chest pain, and the pain is usually a little, a line, a small piece, or symmetry pain in the chest and back. It lasts for a few hours or a whole day, and it feels comfortable after taking a breath. It is often accompanied by upset, palpitations and sweat Poor sleep, even feel that the room is not enough air, feel upset in a crowded place, feel comfortable when you are outdoors or open the window. Seizures are related to emotional tension, stress, and overwork. Taking nitroglycerin is ineffective or takes more than 10 minutes to relieve.

Cardiogenic chest pain other

Cervical or thoracic osteodystrophy Cervical spondylosis is more common in middle-aged and elderly people, and some patients may experience palpitations, chest tightness, episodic analgesia, arrhythmia, and dizziness. Patients often go to the Department of Cardiology first and are often misdiagnosed as angina. The main points for identification are as follows: The duration of epicardial pain caused by cervical spondylosis is longer, usually 1 to 2 hours. No significant effect of antianginal drugs. Artificial compression of the cervical tenderness area can induce angina pectoris-like attacks. This kind of pain in the anterior region of the heart often first shifts from the shoulder, interscapular to the anterior region of the heart. The pain of the neck and arm is increased, and the cough is aggravated. The patient may also be accompanied by other symptoms of cervical spondylosis, such as neck aches and limb numbness . Treatment according to cervical spondylosis can reduce the onset of pain in the anterior heart region.

Spine disorders The spinal nerves and autonomic nerves issued by the cervical and thoracic spinal cord can be distributed to the cell wall, cell membrane, diaphragm muscle, heart and other parts. When the cervical and thoracic spine is injured due to trauma, strain, and coldness in the United States of America, which causes mild dislocations, traction, and inflammatory changes in the joints and vertebral bodies, it can stimulate the relevant spinal or autonomic nerves and cause chest pain. The symptoms of this type of chest pain often increase with the worsening of columnar disease, and with the reduction of spinal disorders.

Cocaine-associated chest pain [8] Chest pain can occur due to excessive use of cocaine. Mainly because the use of cocaine can increase blood pressure and heart rate, thereby increasing myocardial oxygen consumption and contracting coronary arteries. In the West, cocaine accounts for nearly 25% of patients with acute myocardial infarction aged 18-45 years. Such patients have also begun to appear in some large cities in China in recent years, and should be paid attention to. Chest pain is one of the common clinical symptoms. It is the most common in cardiovascular disease. It can be caused by diseases of the chest or chest wall, and it can also come from diseases of the chest and abdominal organs. It includes dull pain, persistent pain, tingling, Burning or oppressive pain; the location and severity of the pain may be inconsistent with the location and severity of the lesion. Chest pain can be divided into cardiogenic chest pain and non-cardiogenic chest pain, and cardiologists often pay more attention or subconscious consideration to cardiogenic chest pain, and do not pay attention to or consider non-cardiogenic chest pain and make many non-cardiogenic Patients with chest pain are not well treated. In addition, the location and severity of chest pain may not be consistent with the lesion and the severity of the disease. Therefore, patients with chest pain should be carefully examined to find the cause of the chest pain as much as possible. For the treatment, only the best chest pain patients can get treatment.

Summary of cardiogenic chest pain

Regarding cardiogenic chest pain, whether acute or chronic, cardiovascular specialists can correctly identify and give the best treatment, and some large cities in China are not far from developed countries in terms of treatment methods and technologies. For non-cardiogenic chest pain, the attention given to cardiovascular disease in China is not enough, and it started late. In the new century, while actively developing new clinical diagnosis and treatment technology research, in order to improve the overall level of cardiovascular disease in China, especially in terms of chest pain, cardiovascular doctors must attach importance to and actively carry out clinical and basic research on noncardiogenic chest pain. . Our country has a large population. As long as we attach importance to work in this field, we will certainly be able to make achievements and enter the international advanced ranks.