CHEST PAIN: (Bates, Table 8-1, P 322-323 on Chest Pain)

A. CVS-RELATED CHEST PAIN

DISEASE Process Quality Region Severity Timing Aggravating Relief Associated
Factors Sx
1. Angina Pectoris Myocardial Pressing, Retrosternal, Mild to Usually 1-3 mins Exertion Nitroglycerin Dyspnea
Ischemia secondary squeezing across the Moderate up to 10 mins Cold Rest Nausea
to coronary Tight anterior chest Sometimes Prolonged up to Temperature Sweating
atherosclerosis Heavy Radiates to felt as 20 mins Meals
Burning shoulders, arms, discomfort Emotion
neck, lower jaw rather than May occur at
or upper pain rest
abdomen

2. Myocardial Cell death: Same as above Same as above Severe 20 mins to hours Nausea None Dyspnea
Infarction Infarction causing Vomitting Nausea
necrosis Vomitting
Weakness

3. Pericarditis Irritation of pleura Sharp and Retrosternal Severe Persistent Breathing Sitting forward Underlying
adjacent to knife-like Precordial Swallowing disease such as
myocardium Crushing Radiates to tip of Change in PTB/ Tumor
shoulder or neck position
Lying down

4. Dissecting Splitting within the Ripping Anterior Chest Very Severe Persistent Hypertension Syncope
Aneurism layers of aortic wall Tearing Wall Abrupt Onset Hemiplegia
Allowed passage Radiates to neck, Paraplegia
of blood back and
Dissected Blood anterior
Channel formation abdomen
Dependent on
the tear of the
aorta
B. Pulmonary-related Chest Pain
DISEASE Process Quality Region Severity Timing Aggravating Relief Associated
Factors Sx
1. Tracheobronchitis Inflammation of Burning Upper sternum Mild to Varying Cough Lying on Cough
Trachea and Bronchi Moderate affected side

2. Pleuritic Pain Inflammation of Sharp or Chest wall Very Severe Persistent Breathing (Deep Splint the area Underlying
secondary to: Parietal Pleura knife-like overlying Inspiration) Lying on illness
(a) Pleuritis inflamed area Coughing affected side
(b) Pleurisy Anterolateral Thoracic Motion
(c) Pulmonary Infarct chest -
(d) Neoplasm nonspecific

C. GIT-related Chest Pain

DISEASE Process Quality Region Severity Timing Aggravating Relief Associated
Factors Sx
1. Gastroesophageal Inflammed lower Burning Retrosternal Mild to severe Varying (short Eating (Large Antacids Regurgitation
Reflux esophagus by Gastric Squeezing Radiate to duration to Meal) Belching Dysphagia
Acid Reflux back days) Bending over
Lying down

2. Diffuse Esophageal Squeezing Restrosternal Mild to severe Varying Swallowing Sometimes by Dysphagia
Esophageal Spasm Muscular Radiate to food nitroglycerin
(sometimes dysfunction back, arm, or Cold liquid
mistaken for Angina jaw Emotional
Pectoris) stress
D. Chest-wall Pain and Anxiety-related Chest Pain
DISEASE Process Quality Region Severity Timing Aggravating Relief Associated
Factors Sx
1. Chest Wall Pain, Unclear Stabbing Below left Varying (Mild, Fleeting (Short) Chest wall Local
(Costochondritis) Sticking breast moderate, or Hours to days motion Tenderness
Dull Along chest severe) Arm motion
Aching wall
Sometimes at
the back

2. Anxiety Unclear Stabbing Precordial Varying Fleeting (Short) Effort Breathlessness

Sticking Below left Hours to days Emotional Palpitation
Dull breast Stress Weakness
Aching Across Anxiety
anterior chest