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Chest pain: how to distinguish between cardiac and noncardiac causes. Dr.Magesh.T MD( USA) MRCP(UK)

hello guys i'm doctor magesto i welcome

you all back to this

news session i know it's been a long

time since i made my last video

uh because i just got held up at my work

because of crazy co-weed

and now here i am uh let's make this a

session today useful and the topic for

today's discussion is chest pain

uh why i'm making this chest pain

serious is because from my previous

video on chest pain

a lot of people you know have asked me

so many questions

you know how to differentiate your spin

from heart or from lungs or from the

other organs in your chest

and when to go see a doctor how to get

it managed

at home and things like that so

this topic is for that okay you want to

get all the answers uh

to your question so please make sure you

watch this video without skipping

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channel or video okay chest pain

uh chest pain like you know it's the

most common complaint that most people

uh you know

complained of when they come into clinic

whether the pain is coming from the

heart lungs

or from the bone skins they do not know

they just have only complaint of chest

pain and we just

as a doctor we have to make sure you

know what this patient is complaining of

whether the chest pain is coming from

the

skin or from the bones or from the

nerves or from the muscles

or from the lungs or from the covering

of the lungs or from the heart itself

things like that there are so many

organs in our chest right and you go

from

superficial to the deep we have a skin

and then under skin we have a

cute fatty layer and then we have a rib

cage's bones

and then we have a brush bones like a

sternum we have here

and down below that we have both sides

lungs

and uh with covering of the lungs pleura

and then in between the lungs we have a

heart and it's

hot layer okay these are the sources

when

any of these organs are get inflamed or

infected or something goes wrong

you get pain okay so

when i see a patient with chest pain i

would always you know

put in some leading questions uh to

navigate or to differentiate or narrow

down

the possible causes of chest pain any

time when patient complains of

pain or chest pain or headache whatever

stomach pain leg pain any pain

we have to uh put these leading

questions to our patient

you have to remember the sick aura sight

is more important

okay where the pain is whether it is in

the left side of the heart or on the

right side of the chest

whether the pain is like so severe or

dull pain or

tabbing pain or short pain or pressure

like kind of discomfort

something like that and the intensity of

pain is very important

s i q o r a

s for sight and eye for intensity of the

pain

you know we always ask we ask our

patient to

grade the pain on a scale of one to ten

where one being the least or ten being

the worst pain

you ever had so so one two ten a patient

would say

doc you know yesterday it was uh two two

over ten now it is six over ten which

means that the pain has gotten worse

so that gives us a clue and next thing

is q

q is quality of pain when you try to

mention the quality

patient would say doctor you know this

pain feels like a stabbing pain as you

feel

you get stabbed by a knife or some

people would say

there's a pricking kind of pain doctor

it just comes in and then goes

comes and goes like that or sometimes

they would say pressure like you know as

i feel like someone is standing on my

chest

that is a quality and onset of pain yes

i q

o o is onset when did the pain start

okay whether the pain started us

gradually

or the pain started right away onset is

a

slow or the fast onset some people they

complain of pain

starts slowly and then builds up or some

people they say

uh pain started right at eight or over

ten

some people would say a pain started at

a one to one over ten

and then it slowly progressed to six

over ten

that's what they would say and then the

radiation sikora or stands for radiation

whether the pain radiates elsewhere

sometimes what happens in a chest pain

that comes from the heart that pain may

radiate into the jaw

or sometimes may read it into the neck

or may read it into the left arms

okay things like that and associated

factors

saqo or ea is a social factor so

we always have to put in this kind of

questions and do you have any other

associated symptoms with this chest pain

like a nausea

or vomiting or shortness of breath

because shortness of breath are more

most commonly associated with your pain

that comes from your heart

nausea vomiting can also be associated

with the heart

and that nausea vomiting can also be

associated with your tummy

stomach problems so nausea vomiting

shortness of breath

or excessive sweating or palpitation

whether you feel that your heart is

beating too fast

or any tiredness and uh or giddiness

these are the associated symptoms and

the second ea

is alleviating factor what makes your

pain go away

does anything make your pain better

things like you are taking some

medication that does it go does it make

your pain

getting better or the other the third

year

is aggravating factor what makes your

pain

worse like when you are doing some work

or when you

climb stretch so when you exert yourself

does the pain get worse

so these are the things s-a-q-o-r-a-a-a

sikora okay when you're done with it

so whether the pain comes from the heart

the causes of

chest pain from the heart there are many

causes

emergency causes are like a heart attack

which what we call it is a

myocardial infarction or myocardial

ischemia

okay this kind of a pain patient would

come

complain of a burning or a pressure like

discomfort

that starts slowly and then i it builds

up

this kind of heart pain does not come

right away and goes off

it won't come just like that it just

comes and stays there for like at least

20 minutes or even more than longer than

that

okay and they always have associated

conditions like associated symptoms like

uh nausea vomiting will be there

sometimes they have also complain of

shortness of breath or palpitation when

they

feel that the heart is beating too fast

or and associated with the excessive

sweating

and the dizziness or giddiness they will

complain of okay

this is one of the uh causes of your

heart

related chest pain and uh there is other

condition called

aortic dissection in which iotic

dissection means the iota it's a big

blood vessel

that comes right off your heart what

happens in iotic dissection

the there is a crack in the layers of

your blood vessel so what happens is the

blood

because of high blood pressure it try to

sips into the crack in between the

layers

and then the crack goes deeper and

deeper and extends

down that causes a severe chest pain

okay

and uh other mild causes like angina

angina is a medical term

in which people get to spin

when they work out or when they do some

work when they exert themselves they get

that chest pain

when the seat and relax they don't get

any pain that is called angina

this antenna can be stable or unstable

okay the difference between angina

and a heart attack heart attack happens

because of

total loss of blood supply to the hot

muscles

but in angina there is a poor blood

supply because blood supply

is half but in hot attack there is a

total loss of blood supply

in angina there is a poor blood supply

to the heart muscles

and this there are some there are many

other causes uh that

hot can cause to spine like a myocardial

infarction that is heart attack

and there's a dissection of iota and

some there there's another condition

called a pericarditis pericarditism

a layer of heart that gets inflamed and

causes pain

when you change your body position many

people say that

their pain gets better when they lean

forward okay

so it could happen in pericarditis

and what are the other organ related

causes for

chest pain when you take lung related

causes

pulmonary embolism pulmonary embolism

means

there is a clot gets detached somewhere

and then goes into the blood vessels in

your lungs

and sits somewhere and blocks the blood

supply

to the distant lung tissues in a short

manner

there is a blood clot in the blood

vessels of your lungs

that causes loss of blood supply in your

lungs that is called pulmonary embolism

this is emergency condition

or there may be other causes like simple

pneumonia inflammation of lungs can

cause chest pain

or it can be pleurisy like inflammation

of your

coverings of your lungs that can be a

cause of chest pain

and stomach causes digestive causes like

a uh

or acid reflux then there is a

connection between

your um throat and your stomach

which is a food pipe at the end of the

food pipe

we have something called low eraser

sphincter that prevents the acid coming

up from the

uh stomach into your food pipe this can

be a

digestive causes of chest pain this is

like a g or d

or sometimes there can be a infection or

inflammation in your gallbladder or

things like that that are called lithius

we call it a gas stones

or that can be a problem in your food

pipe itself

there can be an inflammation or

infection of a food pipe so hot

digestive causes and your lung cancers

are over and there are other causes of

chest pain as well

it could be a simple uh on a panic

attack people comes in with a panic

attack to emergency department

they complain of chest pain and then

they also have

excessive sweating and they also

complain of heart beating too fast

in addition to this they also have a

complaint of fear of

dying okay this panic attack can happen

in a young age like mostly

male or female female is a predominant

and there is another cause of chest pain

uh

what do you call it as shingles this

shingles is a reactivation of the

chickenpox viruses

because of that what happens uh these

people develop chest pain

in addition to chest pain they also have

us my small small blisters

in a form of band in this area or this

area okay

that is called a reactivation of the

chickenpox viruses

i hope i have discussed a little bit

about chest pain

and i would like to continue this uh

session in our next video

we'll discuss on uh how do we diagnose

and how do we manage this uh chest pain

uh so i'll see you all back in our next

session so until then i'm signing out

it's dr mahesh tanaka bye bye guys see

you soon