Management of acute chest pain syndrome

Charles Chambers, D. M. Leaman

Research output: Contribution to journalReview article

Abstract

In differentiating the various etiologies of acute chest pain syndromes, the clinician is faced with identifying life-threatening situations. This article has presented a diagnostic approach for establishing the cardiovascular and noncardiovascular etiologies of acute chest pain syndromes. Cardiovascular etiologies must be identified early upon presentation in order to minimize morbidity and mortality. Myocardial ischemia and particularly necrosis is time dependent: early intervention preserves myocardium, particularly when initiating thrombolytic therapy. Aortic valvular disease, particularly critical aortic stenosis, if unrecognized, can precipitate rapid patient deterioration if inappropriately treated with nitrate therapy for presumed ischemic disease. Aortic dissection, if not properly diagnosed, can progress to stroke, MI, paralysis, and death. Noncardiovascular etiologies are similarly complex but often have less potential for life-threatening consequences. In identifying gastrointestinal bleeding, a careful rectal exam may be safely performed even in the setting of MI. A tension pneumothorax can suddenly compromise vascular return and progress to sudden death if unrecognized. Finally, chest wall symptoms, though seldom life-threatening, can be debilitating to the patient and often respond to anti-inflammatory therapy. In conclusion, the goals of this article were to present a step-wise approach to the diagnosis and management of an often complex presentation. By systematically approaching these patients with a thorough understanding of etiologies, diagnostic options, and therapeutic considerations, both physician anxiety as well as patient complications will be greatly diminished.

Original languageEnglish (US)
Pages (from-to)415-434
Number of pages20
JournalCritical Care Clinics
Volume5
Issue number3
StatePublished - Jan 1 1989

Fingerprint

Acute Chest Syndrome
Acute Pain
Chest Pain
Aortic Diseases
Thrombolytic Therapy
Aortic Valve Stenosis
Thoracic Wall
Pneumothorax
Sudden Death
Paralysis
Nitrates
Myocardial Ischemia
Blood Vessels
Dissection
Myocardium
Anti-Inflammatory Agents
Necrosis
Therapeutics
Anxiety
Stroke

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Chambers, Charles ; Leaman, D. M. / Management of acute chest pain syndrome. In: Critical Care Clinics. 1989 ; Vol. 5, No. 3. pp. 415-434.
@article{1b6f4a6b75194c968291b68ce4863820,
title = "Management of acute chest pain syndrome",
abstract = "In differentiating the various etiologies of acute chest pain syndromes, the clinician is faced with identifying life-threatening situations. This article has presented a diagnostic approach for establishing the cardiovascular and noncardiovascular etiologies of acute chest pain syndromes. Cardiovascular etiologies must be identified early upon presentation in order to minimize morbidity and mortality. Myocardial ischemia and particularly necrosis is time dependent: early intervention preserves myocardium, particularly when initiating thrombolytic therapy. Aortic valvular disease, particularly critical aortic stenosis, if unrecognized, can precipitate rapid patient deterioration if inappropriately treated with nitrate therapy for presumed ischemic disease. Aortic dissection, if not properly diagnosed, can progress to stroke, MI, paralysis, and death. Noncardiovascular etiologies are similarly complex but often have less potential for life-threatening consequences. In identifying gastrointestinal bleeding, a careful rectal exam may be safely performed even in the setting of MI. A tension pneumothorax can suddenly compromise vascular return and progress to sudden death if unrecognized. Finally, chest wall symptoms, though seldom life-threatening, can be debilitating to the patient and often respond to anti-inflammatory therapy. In conclusion, the goals of this article were to present a step-wise approach to the diagnosis and management of an often complex presentation. By systematically approaching these patients with a thorough understanding of etiologies, diagnostic options, and therapeutic considerations, both physician anxiety as well as patient complications will be greatly diminished.",
author = "Charles Chambers and Leaman, {D. M.}",
year = "1989",
month = "1",
day = "1",
language = "English (US)",
volume = "5",
pages = "415--434",
journal = "Critical Care Clinics",
issn = "0749-0704",
publisher = "W.B. Saunders Ltd",
number = "3",

}

Chambers, C & Leaman, DM 1989, 'Management of acute chest pain syndrome', Critical Care Clinics, vol. 5, no. 3, pp. 415-434.

Management of acute chest pain syndrome. / Chambers, Charles; Leaman, D. M.

In: Critical Care Clinics, Vol. 5, No. 3, 01.01.1989, p. 415-434.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Management of acute chest pain syndrome

AU - Chambers, Charles

AU - Leaman, D. M.

PY - 1989/1/1

Y1 - 1989/1/1

N2 - In differentiating the various etiologies of acute chest pain syndromes, the clinician is faced with identifying life-threatening situations. This article has presented a diagnostic approach for establishing the cardiovascular and noncardiovascular etiologies of acute chest pain syndromes. Cardiovascular etiologies must be identified early upon presentation in order to minimize morbidity and mortality. Myocardial ischemia and particularly necrosis is time dependent: early intervention preserves myocardium, particularly when initiating thrombolytic therapy. Aortic valvular disease, particularly critical aortic stenosis, if unrecognized, can precipitate rapid patient deterioration if inappropriately treated with nitrate therapy for presumed ischemic disease. Aortic dissection, if not properly diagnosed, can progress to stroke, MI, paralysis, and death. Noncardiovascular etiologies are similarly complex but often have less potential for life-threatening consequences. In identifying gastrointestinal bleeding, a careful rectal exam may be safely performed even in the setting of MI. A tension pneumothorax can suddenly compromise vascular return and progress to sudden death if unrecognized. Finally, chest wall symptoms, though seldom life-threatening, can be debilitating to the patient and often respond to anti-inflammatory therapy. In conclusion, the goals of this article were to present a step-wise approach to the diagnosis and management of an often complex presentation. By systematically approaching these patients with a thorough understanding of etiologies, diagnostic options, and therapeutic considerations, both physician anxiety as well as patient complications will be greatly diminished.

AB - In differentiating the various etiologies of acute chest pain syndromes, the clinician is faced with identifying life-threatening situations. This article has presented a diagnostic approach for establishing the cardiovascular and noncardiovascular etiologies of acute chest pain syndromes. Cardiovascular etiologies must be identified early upon presentation in order to minimize morbidity and mortality. Myocardial ischemia and particularly necrosis is time dependent: early intervention preserves myocardium, particularly when initiating thrombolytic therapy. Aortic valvular disease, particularly critical aortic stenosis, if unrecognized, can precipitate rapid patient deterioration if inappropriately treated with nitrate therapy for presumed ischemic disease. Aortic dissection, if not properly diagnosed, can progress to stroke, MI, paralysis, and death. Noncardiovascular etiologies are similarly complex but often have less potential for life-threatening consequences. In identifying gastrointestinal bleeding, a careful rectal exam may be safely performed even in the setting of MI. A tension pneumothorax can suddenly compromise vascular return and progress to sudden death if unrecognized. Finally, chest wall symptoms, though seldom life-threatening, can be debilitating to the patient and often respond to anti-inflammatory therapy. In conclusion, the goals of this article were to present a step-wise approach to the diagnosis and management of an often complex presentation. By systematically approaching these patients with a thorough understanding of etiologies, diagnostic options, and therapeutic considerations, both physician anxiety as well as patient complications will be greatly diminished.

UR - http://www.scopus.com/inward/record.url?scp=0024311573&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024311573&partnerID=8YFLogxK

M3 - Review article

C2 - 2670088

AN - SCOPUS:0024311573

VL - 5

SP - 415

EP - 434

JO - Critical Care Clinics

JF - Critical Care Clinics

SN - 0749-0704

IS - 3

ER -