Chest Pain课件.pptVIP

Noncardiac Cause of Chest Pain Part I : GI and aortic dissection Part II : Pulmonary, Psychiatric, and Musculoskeletal cause GI cause of NCCP Esophageal perforation ( Boerhaave’s syndrome ) GERD Esophageal Motility Disorder Achalasia Diffuse esophageal spasm Nutcracker esophagus Hypertensive LES Non-specific esophageal motility disorder Syndrome X Visceral hyperalgesia Esophageal perforation Most leathal esophageal cause of NCCP Order than 50 years of age With underlying esophageal pathology (ex : cancer ) Post-endoscopy Retain esophageal foreign body Esophageal perforation Symptoms: Chest pain Fever Painful respiration P.E. Hamman’s crunch Subcutaneous emphysema in the neck Esophageal perforation CXR: Mediastinal emphysema Penumothorax Widening of the mediastinum Left pleural effusion Survival rates 和診斷及開始治療的快慢有關 Esophageal perforation Esophagography Extravasation of contrast into mediastinum ED Treatment Fluid resuscitation Antibiotics Surgical consultation GERD When pH is persistently below 4.0 Cause pain Direct injury Alteration the pain sensation threshold traditionally : direct injury cause pain Recently : chronic exposure to acid lower the threshold to pain GERD Clinical presentation Indistinguishable from acute coronary ischemia Burning mid-chest pain Nausea Diaphoresis S.O.B. GERD Omeprazole challenge test (acid suppression test) 20~40mg in the morning and 20mg in the evening for one week 78~81% vs 6~14% Both diagnostic and therapeutic If fail - further evaluation for other causes of NCCP Esophageal Motility Disorder Abnormal peristaltic movement Table 2. Treatment Calcium channel blocker Diltiazem Nifedipine Endoscopic treatment Ballon dilation of LES Botulinum toxin injection into LES Syndrome X Chest pain objective signs of ischemia in exercise testing or myocardial scintography BUT normal coronal arteries Cause : unknown 67%-balloon distension cause pain 47%-acid perfusion cause pain 37%-abnormal motility Visceral Hyperalgesia Lower pain thres