| Doctor, I get pain on the left side of chest off & on. I am worried about my heart… Yes! I too, am worried whether it is cardiac or non-cardiac. And I can see the anxiety on your face, which may be an important factory in the pain! Show me exactly where it pains. (cardiac pain is more retrosternal, than left sided, and constricting type) Is it pain or a constricting, choking sensation? “It is painful.” (so more likely to be non-cardiac) Does it radiate to the left arm or lower jaw? “No” If you walk fast or climb stairs, does it appear? Does it stop quickly if you rest? “No, but it is more when I bend forwards or lift something in my hands.” (this is more like a chest wall pain) Does it increase on taking a deep breath or coughing? Take a deep breath and tell me, “No.” (That rules out pleural pain.) Does it pain when you are swallowing food? “No”. (that rules out oesophaitis, which gives Retrosternal pain, more while swallowing) Perform a quick General examination of eyes, tongue, nails & feet. Inspect the chest, look for scars of Herpes Zoster. Palpate firmly over the costochondral junctions on both sides. (About 1” parasternal) for tenderness. (this is the only way to diagnose costo-chondritis) Palpate for intercostals tenderness. Auscultate RS for pleural rub or rales And CVS for pericardial rub and murmurs. Palpate the abdomen for liver, spleen & epigastric tenderness. Check the Blood pressure. Examine the neck movements. Pain of cervical spondylitis can radiate to chest. Key points for left chest pain: Cardiac or Non-cardiac? B.P., costo-condral tenderness, intercostals tenderness, auscultate RS & CVS, Tenderness upper abdomen, cervical spondylitis. Action: Since everything appears normal, and pain is not suggestive of angina at all, give NSAID, local liniments & fomentations, Tranquilizer and S.O.S. antibiotic. If relief is not seen, ask for x-ray chest, ECG refer to a physician. (if the pain was anginal type, administer sorbitrate and Disprin, and refer immediately to a physician or cardiologist) |
