Chest Pain and Chest Discomfort
Angina
General tight, band like, crushing pain felt across the front of the chest. It is generally brought on by exertion and relieved within 5 minutes of rest or after taking trinitrin.
Angina pain occurs when the heart muscle is starved for oxygen generally caused by narrowing of the coronary arteries. The pain has also been known to start as chest pain and radiate towards the jaw or down into the left or both arms. If the chest pain lasts longer than 20 minutes it is most likely due to myocardial infarction.
Types of Angina
Decubitus Angina
Chest pain when laying flat, generally appears with myocardial ischaemia
Nocturnal Angina
Chest pains which awaken the individual while sleeping
Acute Coronary Insufficiency Angina
Severe chest pain suggesting myocardial infarction but without any investigatory confirmation of infarction.
Unstable Angina
Chest pain that has become significantly worse within the previous 4 weeks (approximately). It may have started as stable angina but progressed to this unstable state. Generally in this progressed state Trinitrin does not relieve the angina chest pains.
Crescendo Angina
Chest pain which slowly increases in frequency and severity over a very short period of time. It is usually a pre-infarctive condition.
Aortic Dissection
Severe and tearing pain located in the chest or in the abdomen depending on where in the aorta the tearing is situated. Dissections occurs when there is a tear in the innermost layer of the arterial wall. Blood will dissect the vessel wall into two layers interfering with normal blood flow. Organs post dissection may lack blood creating an infarction in those organs creating other symptoms besides the extreme pain.
Myocardial Infarction
Sudden Chest pain which is severe in nature and often described as a heavy and tight pain (vice-like pain). People have described the pain as “if an elephant was standing on my chest”. A general concomitant symptom is whole body profuse sweating. The chest pain in myocardial infarctions are similar to that of angina pain but the pain will not be relieved by trinitrin, rest and will last in excess of 20 minutes. In myocardial infarction the patient may also feel shortness of breath and light headed ness and the patient may also collapse. In some cases the pains are thought to be digestive instead of cardiovascular while in some other cases there may not be pain, a “painless” heart attack.
The pain of a myocardial infarction is caused by the lack of oxygen and nutrients provided to the heart via the blood stream. This inadequate oxygenation of the heart muscle causes heart cell death or “necrosis”.
Pericarditis
Sudden sharp chest pain mimicking the same symptoms of a myocardial infarction or angina. The chest pain my be affected by breathing and may persist for several days and may recur. Generally, pericarditis is presumed to have a viral cause and therefore show flu like symptoms prior to the attack.
Pleuritic Chest Pain
A sharp, stabbing, well-localized chest pain which is aggravated on deep inspiration. The pain is caused by an irritation of the outer pleura which becomes inflamed.
Superficial Chest pain
This type of chest pain has many causes and many types of pain. It can be sharp and localized as in shingles (along a nerve ganglia) or dull and continuous as in intrapulmonary malignancies. There are many types of pains and many diseases which may cause this type of pain.
Tracheal Pain
Generally tracheal chest pain is felt behind the sternum and miastinal pain may feel similar to cardiac pain. Tracheal pain is distinguished from cardiac pain in that it is not aggravated by exercise.
Tags: Angina, Aortic, Chest, Dissection, Pleuritic, Superficial, Tracheal
Elbow Joint Pain
The elbow joint is a hinge joint of the arm. The bone of the upper arm (humerus) and the two bones of the forearm (ulna and radius) join at the elbow. The elbow joint allows the forearm to bend and extend and to roll from side to side. The elbow is a common site of injury, especially from sports.
Arthritis
Elbow joint pain due to arthritis will have marked swelling and tenderness between the groove of the olecranon process and the lateral epicondyle.
Bursitis of the Olecranon
Elbow joint pain due to bursitis will have superficial swelling of the olecranon bursa which suggests bursitis. The pain and condition may be acute bursitis or chronic bursitis. Either acute or chronic, bursitis of the olecranon will give elbow joint pain of similar nature.
Fractured Elbow Joint
When the elbow joint is fractured there will be severe pain post traumatic injury. There will be local tenderness in the elbow joint along with reluctance to move the joint due to pain.Golfers Elbow - Epicondylitis
A painful tender medial epicondyle of the elbow joint suggests medial epicondilitis It is also commonly known as a pitchers elbow or little league elbow. There is general pain of the elbow joint when there is resistance against wrist flexion.Rheumatoid Nodules
Rheumatoid nodules are subcutaneous firm and non tender. These nodules of the elbow joint are found along the extensor suface of the ulna and may attach to the underlying periosteum. They are commonly found in disorders of theumatoid arthritis or acute rheumatic fever.Tennis Elbow - Epicondylitis
A painful and tender lateral epicondyle of the elbow joint suggests tennis elbow or lateral epicondylitis Extension of the wrist against resistance increases the pain.
Tags: Arthritis, Elbow, Golfers, Joint, Rheumatoid, Tennis
Abdominal Pain
Aortic Pain
Aortic pain can be severe and may have a tearing component if there is associated expanding, leaking or dissecting aneurysm. Abdominal pains are usually most marked in the back and may originate in the chest and spread down the legs.
Anal Pain
Anal pain is usually well localized around the anal area of the perineal region. It is most often caused by fissures or piles. Anal abdominal pain is aggravated by defaecation. The anal fissures are narrow splits in the perianal skin, usually in the midline posteriorly which extend towards the anal edge where a sentinel pile may be found. Fissures are generally very painful.
Appendix Pain
Generally appendix abdominal pain has a persistent pain wtarting in the central abdomen and then will localize to the right lower quadrant at Mc Burneys point. The pain can called re-bound pain as it is often more painful when the area is released during palpation which brings more pain.
Biliary Tract Pain
Biliary tract abdominal pain classically is felt in the right upper quadrant and may radiate to the midline of the body. Biliary tract pain may also radiate towad the right scapula. The pain is often a minor discomfort but in the case of gallstones passing down this tract biliary colic may result and extreme pain ensures. (biliary colic is not colic!)
Bladder Pain
Bladder pain is a midline pain felt just above the pubic bone. It is often associated with frequency, dysuria and other symptoms of urinary tract infections. Bladder pain and bladder inflammation (cystitis) will not cause a fever or renal pail unlike renal tissue inflammation (pyelonephritis). Acute bladder pain is most commonly caused by retention of urine in the bladder.
Colic Pain or Colicky Pain
Colic abdominal pain is a squeezing pain which can vary it’s intensity. Patients experiencing colic pain often indicate the squeezing nature by clenching their fists. Colic almost invariably denotes abnormality in hollow organs.
Gastric Pain and Duodenal Pain
Gastric and duodenal pains are often poorly defined upper abdominal pains which can also be felt in the back in accordance with meals. It can be a gnawing pain which may be relieved by antacids.
Duodenal pain may be localized by the patient who can point directly to the xiphisternal area. The pain is aggravated when the patients stomach is empty therefore will habitually awaken the patient at night (duodenal lesions). In general, duodenal pain will be relieved after eating a meal but if the pain is aggravated by foods it will be gastric.
If the pain radiates to the back it generally suggests posterior penetration of gastric or duodenal ulcer. When a ulcer perforates the pain will become more generalized (unless ulcer is small)
Hepatic Pain or Liver Pain
Hepatic abdominal pain is usually in the right upper quadrant giving rise to more mild pain or discomfort than severe pain. If the pain is severe, this may indicate heart failure or acute hepatitis. Damage to the liver tissue does not give rise to pain! It is the stretching of various other tissues (hepatic capsule) which causes the pain.
Large Intestine Pain
Large intestine (colonic) abdominal pain tends to be most predominantly felt in the central abdomen if the ascending or transverse colon is affected. If the descending colon is affected the discomforting pain will be felt in the lower abdomen below the umbilicus.
Liver Pain
Hepatic abdominal pain is usually in the right upper quadrant giving rise to more mild pain or discomfort than severe pain. If the pain is severe, this may indicate heart failure or acute hepatitis. Damage to the liver tissue does not give rise to pain! It is the stretching of various other tissues (hepatic capsule) which causes the pain.
Oesophageal Pain
Esophagus abdominal pain is pain felt in the midline of the body and retrosternal. This occasionally simulates cardiac pain. Oesophageal pain may radiate down the back or into the arms in a similar fashion to angina. Esophagus pain is aggravated when hot or bulky foods are swallowed. This type of pain may be caused by heartburn if the sensation is burning or hot and is closer in the chest. This may also indicate problems with peristalsis or achalasia.
Ovarian Pain
Pancreatic Pain
Pancreatic abdominal pain is felt in the upper quadrants and usually also in the back. This pain may be worse when the patient is lying down (pancrease indents with spine) and may be relieved by bending over forwards. Abdominal pain caused by acute pancreatitis is generally a severe and constant pain and may be caused by alcohol abuse or biliary tract disease.
Peritoneal pain
Abdominal pain due to peritoneal irritation gives rise to peritoneal pain. Focal irritation produces localized abdominal pain but generalized peritonitis with generalized irritation produces generalized pain with rebound tenderness.
Prostatic Pain
Prostate pain is predominantly perineal and possibly associated with other prostate symptoms. A loaded rectum of digital rectal examination may cause prostate discomfort.
Rectal Pain
Abdominal Pain due to rectal disorders is usually well localized with abrupt onset and severe pain if it is due to proctalgia fugax (cramping of pelvic floor muscles)
Renal Colic - Ureteric Pain
Ureteric pain is a sudden onset, unilateral, severe pain with periodic exacerbation felt in the lateral abdomen. The pain can radiate downwards towards the external genitalia making the pain extreme.
Renal Pain
Renal pain is most often associated with stretching or irritation of the renal capsule. There is generally constant pain which radiates to the back with some tenderness which runs from the back to the 12th rib. Pain may also radiate downwards in ureteric fashion.
Small Intestine Pain
Small intestinal abdominal pain is a colicky and periumbilical when due to inflammatory or infective causes. Small intestine colic tends to have more frequent variations in intensity than does large intestinal colic. When the blood supply is impaired there may be mesenteric angina with pain after eating lasting until blood deficiency of the gut ends. Terminal ileal pain tends to be localized to the right lower quadrant. Complete arterial blockage with intestinal infarction causes sudden onset central abdominal pain with circulatory collapse.
Splenic Pain
Pain of the spleen is a left upper quadrant pain which may vary as the spleen moves with each breath. This tuype of abdominal pain can be caused by spleenic infarction which occurs in sickle cell disease.
Ureteric Pain – Renal Colic
Ureteric pain is a sudden onset, unilateral, severe pain with periodic exacerbation felt in the lateral abdomen. The pain can radiate downwards towards the external genitalia making the pain extreme.
Tags: Bladder, Hepatic, Large Intestine, Peritoneal, Prostatic, Renal, Small Intestine, Splenic, Ureteric
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