STUDY - Technical - New Dacian's Medicine
Chest
Discomfort and Palpitations (2).
Translation Draft
We continue the previously opened topic by proceeding to the gastrointestinal causes of chest discomfort. Esophageal pain usually presents as a deep, burning chest discomfort, which is the mark of pain induced by acid irritation. Ingestion of aspirin, alcohol or certain foods characteristically exacerbates the burning sensation, and discomfort can be promptly relieved by antacids or even one, two sips of food or water. Patients may simultaneously experience dysphagia, regurgitation of undigested food or weight loss.
Symptoms of a hiatal hernia tend to be exacerbated by clinostatism, and all symptoms of acidopeptic disease can be accentuated in the morning, when acid secretions are not neutralized by food. Esophageal spasm, which can be caused by the reflux of gastric acid in an esophagus in which the mucosa has previously been irritated, can cause a compression sensation that cannot be differentiated from that in myocardial ischemia and which may even irradiate similarly.
Occasionally, other gastrointestinal diseases including peptic ulcerative disease, biliary disorders and pancreatitis may be accompanied by chest and abdominal discomfort. Pain in gastric or duodenal ulcers is epigastric or retrosternal and usually begins about 1 to 1.5 hours after eating and is usually improved within minutes of antacids or milk.
Discomfort caused by acute cholecystitis is commonly described as a continuous pain, which can be epigastric or retrosternal occurring, usually, about an hour after eating and is unrelated to exertion. The presence of an abdominal condition, such as hiatal hernia or duodenal ulcer, is not evidence that the patient's chest pain is related to it. Such conditions are frequently asymptomatic and are not at all unusual in patients who also have myocardial ischemia.
Other causes of chest discomfort are neuromusculoskeletal ones. Discomfort can be caused by cervical disc disease due to compression of nerve roots, arthritis of the shoulder or spine or costocondritis (inflammation of the costocondral joints). Inflammation of the subacromial or, less commonly, deltoid or supraspinous tendon may cause pain radiating to the thorax.
Then, it should not be forgotten about the cramps of the intercostal muscles that can occur anywhere in the chest. Also, hyperabductionation and anterior scalen muscle syndromes can cause chest discomfort. The costocondral and costosternal joints are the most common localizations of previous chest pain.
Objective signs, i.e. inflammation (Tietze syndrome), redness and local heat are rare, but well-located sensitivity is common. Pain can be a sagging, lasting only a few seconds, or it can be a source pain of hours or days. An associated feeling of tension caused by muscle spasm may also occur quite frequently. Pressure in the condrosternal and costocondral joints and on the pectoral muscles is an essential part of the examination of each patient with chest pain and will reproduce the pain that originates in these tissues.
We are now entering a fragile territory that is particularly related to the new medicine, the psychogenic causes of chest pain (but we will limit ourselves, for the moment, still only to the accumulations of classical medicine). Emotional disorders are also commonly associated with chest pain.
Usually, discomfort is felt as a kind of "tension", sometimes called "neuralgia", and occasionally can be severe enough to be described as a pain of considerable intensity. Since discomfort can be described as a strain or constriction and is often localized in the lower sternum, it is not at all surprising that this type of discomfort is very often confused with that of myocardial ischemia.
Normally it takes half an hour or more, has nothing to do with effort and has a slow fluctuation in intensity. The association with fatigue or emotional strain is usually evident, although it may not be recognized by the patient. In addition, associated hyperventilation may cause perceptions that may be confused with coronary artery disease. Other times, chest pain associated with emotional disorders can be sharp and very short, located near the left nipple.
Essential in assessing the patient with chest discomfort is to distinguish life-threatening conditions such as coronary artery disease, aortic dissection and pulmonary embolism. Even though patients who have had short episodes of pain and are apparently healthy may have intermittent myocardial ischemia or recurrent pulmonary embolism.
A useful approach is to determine whether the pain is new, acute, present during the examination, whether it is episodic, recurrent or whether it is persistent. Note that each of the situations that can cause chest discomfort can have various manifestations, and diagnostic tests can have different results.
Information obtained from careful anamnesis and physical examination can be used to develop a differential diagnosis of the causes of chest discomfort, to order these diagnostic possibilities and often to give them an approximate probability.
Although the various causes of chest discomfort have typical characteristics, they must be interpreted in light of the previous probability that the person of a particular sex, age and medical history has a certain cause of chest discomfort.
For example, the possibility that angina may be the cause of precordial or retrosternal discomfort should be seriously considered in the case of a middle-aged patient with coronary risk factors such as hypercholesterolemia and smoking, even if the description of discomfort is not perfectly typical for angina. On the contrary, when a woman in her 20s describes the onset of discomfort in a manner that seems classic for angina, such a diagnosis is relatively unlikely, because the likelihood of ischemic heart disease is very low, given the age and sex.
Although it is not always possible to assess the probabilities of the various causes of chest discomfort, relative probabilities of different potential explanations for any chest discomfort syndrome are given.
For example, an elderly or middle-aged man with typical characteristics of angina is about 85% likely to have significant hemodynamic coronary artery disease. By comparison, the same man with a history of chest discomfort with some typical characteristics for angina, but also other characteristics that are atypical, will have a probability of significant coronary disease, oscillating between 30 and 60%.
Even people with chest pain who clearly do not have coronary artery disease still have definite possibilities for coronary artery disease, which can range from an extremely low percentage for young women to 10% in a middle-aged man. And with that, that's enough for chest discomfort.
Let's get to the palpitations now! palpitations are a common, unpleasant symptom that can be defined as the state of awareness of the heartbeat, caused by changes in heart rate or heart rate or an increase in its contractility.
Palpitation is not pathognomonic to a particular group of disorders, most of the time it does not signify a primary physical disorder, but rather a psychological disorder. Even when more or less obvious suffering occurs, the diagnosis of the underlying disease is largely made associating other symptoms and information.
However, palpitation is considered important for patients, who fear it may indicate heart disease. The fear is greater in patients who have been told that they may have heart disease, with palpitations appearing as a sign of impending disaster.
Since the resulting anxiety can be associated with increased activity of the vegetative nervous system, with the consequent increase in heart rate, rhythm and intensity of contraction, the fact that the patient is aware of these changes can lead to a vicious sky, which ultimately may be responsible for disability.
Palpitations can be described by the patient in different ways, such as "striking", "striking" or "jumping" and in most cases it will be obvious that the accusations consist of a feeling of heart rhythm disorder. Sensitivity to changes in cardiac activity of different subjects varies greatly.
Some patients seem unaware of the most serious and chaotic arrhythmias while others are deeply concerned about occasional extrasistoles. Patients with anxiety often have a lower threshold at which frequency and rhythm disorders appear as palpitations. Heart rate awareness tends to be more common at night or in moments of introspection and less marked during activity.
Patients with organic heart disease and chronic heart rate, rhythm or volume disorders tend to get used to these abnormalities and are often less sensitive in these situations than normal patients. Persistent tachycardia and/ or atrial fibrillation may not be accompanied by continuous palpitation, in contrast to a sudden, short change in heart rate, which often causes considerable discomfort to the patient.
Palpitation is particularly evident when the causes of increased heart rate, contractility or arrhythmia are recent, transient and episodic. On the contrary, in the case of emotionally balanced individuals, palpitation becomes progressively less noticeable as it is chronicled.
The most important clue for etiology is the description of palpitations. Everything possible must be done to ask the patient to check his radial pulse during episodes of palpitations. If the rhythm is stable and regular with normal frequency, the patient perceives his heart rate due to an abnormal beating volume, as it is in aortic insufficiency, but more likely he focuses his attention excessively on a normal cardiac function, sometimes in response to daily stress.
Conversely, if the rhythm is stable and regular, but the frequency is clearly increased, especially over 120 beats per minute at a time when activity or stress does not justify a tachycardia, palpitations can very well represent a supraventricular or even ventricular tachycardia. But an irregular pulse found during an episode of palpitations almost always represents a true arrhythmia (simple or as an isolated extrasystole).
Premature contraction and post-premature beating of an extrasystole are commonly described as a "strike," or the patient may say that his heart has "turned." The pause following a premature contraction can be felt as a temporary stop of the heartbeat and the first ventricular contraction after the break can be felt as unusually strong and often described as a "twitch" or a "bubble".
All arrhythmic causes of palpitations may be more common in the presence of thyrotoxicosis, hypoglycaemia, pheochromocytoma, fever and other medicines. These arrhythmias can also be precipitated by tobacco, coffee, tea, alcohol, epinephrine, ephedrine, aminophilin, atropine or thyroid medication.
As a rule, palpitations themselves frequently produce anxiety and fear disproportionate to the severity of the condition that caused them. When the cause has been precisely determined and its significance has been explained to the patient, the patient's concern is frequently improved or disappears.
We continue the previously opened topic by proceeding to the gastrointestinal causes of chest discomfort. Esophageal pain usually presents as a deep, burning chest discomfort, which is the mark of pain induced by acid irritation. Ingestion of aspirin, alcohol or certain foods characteristically exacerbates the burning sensation, and discomfort can be promptly relieved by antacids or even one, two sips of food or water. Patients may simultaneously experience dysphagia, regurgitation of undigested food or weight loss.
Symptoms of a hiatal hernia tend to be exacerbated by clinostatism, and all symptoms of acidopeptic disease can be accentuated in the morning, when acid secretions are not neutralized by food. Esophageal spasm, which can be caused by the reflux of gastric acid in an esophagus in which the mucosa has previously been irritated, can cause a compression sensation that cannot be differentiated from that in myocardial ischemia and which may even irradiate similarly.
Occasionally, other gastrointestinal diseases including peptic ulcerative disease, biliary disorders and pancreatitis may be accompanied by chest and abdominal discomfort. Pain in gastric or duodenal ulcers is epigastric or retrosternal and usually begins about 1 to 1.5 hours after eating and is usually improved within minutes of antacids or milk.
Discomfort caused by acute cholecystitis is commonly described as a continuous pain, which can be epigastric or retrosternal occurring, usually, about an hour after eating and is unrelated to exertion. The presence of an abdominal condition, such as hiatal hernia or duodenal ulcer, is not evidence that the patient's chest pain is related to it. Such conditions are frequently asymptomatic and are not at all unusual in patients who also have myocardial ischemia.
Other causes of chest discomfort are neuromusculoskeletal ones. Discomfort can be caused by cervical disc disease due to compression of nerve roots, arthritis of the shoulder or spine or costocondritis (inflammation of the costocondral joints). Inflammation of the subacromial or, less commonly, deltoid or supraspinous tendon may cause pain radiating to the thorax.
Then, it should not be forgotten about the cramps of the intercostal muscles that can occur anywhere in the chest. Also, hyperabductionation and anterior scalen muscle syndromes can cause chest discomfort. The costocondral and costosternal joints are the most common localizations of previous chest pain.
Objective signs, i.e. inflammation (Tietze syndrome), redness and local heat are rare, but well-located sensitivity is common. Pain can be a sagging, lasting only a few seconds, or it can be a source pain of hours or days. An associated feeling of tension caused by muscle spasm may also occur quite frequently. Pressure in the condrosternal and costocondral joints and on the pectoral muscles is an essential part of the examination of each patient with chest pain and will reproduce the pain that originates in these tissues.
We are now entering a fragile territory that is particularly related to the new medicine, the psychogenic causes of chest pain (but we will limit ourselves, for the moment, still only to the accumulations of classical medicine). Emotional disorders are also commonly associated with chest pain.
Usually, discomfort is felt as a kind of "tension", sometimes called "neuralgia", and occasionally can be severe enough to be described as a pain of considerable intensity. Since discomfort can be described as a strain or constriction and is often localized in the lower sternum, it is not at all surprising that this type of discomfort is very often confused with that of myocardial ischemia.
Normally it takes half an hour or more, has nothing to do with effort and has a slow fluctuation in intensity. The association with fatigue or emotional strain is usually evident, although it may not be recognized by the patient. In addition, associated hyperventilation may cause perceptions that may be confused with coronary artery disease. Other times, chest pain associated with emotional disorders can be sharp and very short, located near the left nipple.
Essential in assessing the patient with chest discomfort is to distinguish life-threatening conditions such as coronary artery disease, aortic dissection and pulmonary embolism. Even though patients who have had short episodes of pain and are apparently healthy may have intermittent myocardial ischemia or recurrent pulmonary embolism.
A useful approach is to determine whether the pain is new, acute, present during the examination, whether it is episodic, recurrent or whether it is persistent. Note that each of the situations that can cause chest discomfort can have various manifestations, and diagnostic tests can have different results.
Information obtained from careful anamnesis and physical examination can be used to develop a differential diagnosis of the causes of chest discomfort, to order these diagnostic possibilities and often to give them an approximate probability.
Although the various causes of chest discomfort have typical characteristics, they must be interpreted in light of the previous probability that the person of a particular sex, age and medical history has a certain cause of chest discomfort.
For example, the possibility that angina may be the cause of precordial or retrosternal discomfort should be seriously considered in the case of a middle-aged patient with coronary risk factors such as hypercholesterolemia and smoking, even if the description of discomfort is not perfectly typical for angina. On the contrary, when a woman in her 20s describes the onset of discomfort in a manner that seems classic for angina, such a diagnosis is relatively unlikely, because the likelihood of ischemic heart disease is very low, given the age and sex.
Although it is not always possible to assess the probabilities of the various causes of chest discomfort, relative probabilities of different potential explanations for any chest discomfort syndrome are given.
For example, an elderly or middle-aged man with typical characteristics of angina is about 85% likely to have significant hemodynamic coronary artery disease. By comparison, the same man with a history of chest discomfort with some typical characteristics for angina, but also other characteristics that are atypical, will have a probability of significant coronary disease, oscillating between 30 and 60%.
Even people with chest pain who clearly do not have coronary artery disease still have definite possibilities for coronary artery disease, which can range from an extremely low percentage for young women to 10% in a middle-aged man. And with that, that's enough for chest discomfort.
Let's get to the palpitations now! palpitations are a common, unpleasant symptom that can be defined as the state of awareness of the heartbeat, caused by changes in heart rate or heart rate or an increase in its contractility.
Palpitation is not pathognomonic to a particular group of disorders, most of the time it does not signify a primary physical disorder, but rather a psychological disorder. Even when more or less obvious suffering occurs, the diagnosis of the underlying disease is largely made associating other symptoms and information.
However, palpitation is considered important for patients, who fear it may indicate heart disease. The fear is greater in patients who have been told that they may have heart disease, with palpitations appearing as a sign of impending disaster.
Since the resulting anxiety can be associated with increased activity of the vegetative nervous system, with the consequent increase in heart rate, rhythm and intensity of contraction, the fact that the patient is aware of these changes can lead to a vicious sky, which ultimately may be responsible for disability.
Palpitations can be described by the patient in different ways, such as "striking", "striking" or "jumping" and in most cases it will be obvious that the accusations consist of a feeling of heart rhythm disorder. Sensitivity to changes in cardiac activity of different subjects varies greatly.
Some patients seem unaware of the most serious and chaotic arrhythmias while others are deeply concerned about occasional extrasistoles. Patients with anxiety often have a lower threshold at which frequency and rhythm disorders appear as palpitations. Heart rate awareness tends to be more common at night or in moments of introspection and less marked during activity.
Patients with organic heart disease and chronic heart rate, rhythm or volume disorders tend to get used to these abnormalities and are often less sensitive in these situations than normal patients. Persistent tachycardia and/ or atrial fibrillation may not be accompanied by continuous palpitation, in contrast to a sudden, short change in heart rate, which often causes considerable discomfort to the patient.
Palpitation is particularly evident when the causes of increased heart rate, contractility or arrhythmia are recent, transient and episodic. On the contrary, in the case of emotionally balanced individuals, palpitation becomes progressively less noticeable as it is chronicled.
The most important clue for etiology is the description of palpitations. Everything possible must be done to ask the patient to check his radial pulse during episodes of palpitations. If the rhythm is stable and regular with normal frequency, the patient perceives his heart rate due to an abnormal beating volume, as it is in aortic insufficiency, but more likely he focuses his attention excessively on a normal cardiac function, sometimes in response to daily stress.
Conversely, if the rhythm is stable and regular, but the frequency is clearly increased, especially over 120 beats per minute at a time when activity or stress does not justify a tachycardia, palpitations can very well represent a supraventricular or even ventricular tachycardia. But an irregular pulse found during an episode of palpitations almost always represents a true arrhythmia (simple or as an isolated extrasystole).
Premature contraction and post-premature beating of an extrasystole are commonly described as a "strike," or the patient may say that his heart has "turned." The pause following a premature contraction can be felt as a temporary stop of the heartbeat and the first ventricular contraction after the break can be felt as unusually strong and often described as a "twitch" or a "bubble".
All arrhythmic causes of palpitations may be more common in the presence of thyrotoxicosis, hypoglycaemia, pheochromocytoma, fever and other medicines. These arrhythmias can also be precipitated by tobacco, coffee, tea, alcohol, epinephrine, ephedrine, aminophilin, atropine or thyroid medication.
As a rule, palpitations themselves frequently produce anxiety and fear disproportionate to the severity of the condition that caused them. When the cause has been precisely determined and its significance has been explained to the patient, the patient's concern is frequently improved or disappears.
A
pleasant and useful weekend! And let's not forget to give our
marches to all the little girls, girls, ladies and ladies in
our lives!
Dorin, Merticaru