WordNet

used to express refusal or denial or disagreement etc or especially to emphasize a negative statement; "no, you are wrong"
a negative; "his no was loud and clear"
referring to the degree to which a certain quality is present; "he was no heavier than a child" (同)no more
not in any degree or manner; not at all; "he is no better today"
quantifier; used with either mass nouns or plural count nouns for indicating a complete or almost complete lack or zero quantity of; "we have no bananas"; "no eggs left and no money to buy any"; "have you no decency?"; "did it with no help"; "Ill get you there in no time"
cause emotional anguish or make miserable; "It pains me to see my children not being taught well in school" (同)anguish, hurt
a symptom of some physical hurt or disorder; "the patient developed severe pain and distension" (同)hurting
a bothersome annoying person; "that kid is a terrible pain" (同)pain in the neck, nuisance
a somatic sensation of acute discomfort; "as the intensity increased the sensation changed from tickle to pain" (同)pain_sensation, painful sensation
emotional distress; a fundamental feeling that people try to avoid; "the pain of loneliness" (同)painfulness
box with a lid; used for storage; usually large and sturdy
of or relating to the heart; "cardiac arrest"

PrepTutorEJDIC

《名詞の前に置いて》『一つも』(『一人も,少しも』)・・・『ない』 / 《補語につけて》『決して・・・でない』 / 《省略文で》・・・なし;・・・お断り / 《話》少ししか(あまり)・・・ない / (肯定の問いに対して)『いいえ』;(否定の問いに対して)はい,ええ / 《not, norの前に挿入して》『いや』,否 / 《形容詞の前に置その形容詞を否定して》…どころではない / 《比較級の前に置いて》ちっとも…でない,…と全く同じ / 《… or no の形で》…であってもなくても / 《驚き・困惑・不信などを表して》とんでもない / 《単数形で》『拒否』,「『いいえ』」という返事 / 《複数形で》反対[投]票
〈C〉〈U〉(肉体のある部分の)『苦痛』,『痛み』 / 〈U〉(精神的な)『苦痛』,心痛 / 《複数形で》骨折り,苦労,努力 / 〈C〉不快感,いやな感じ;うんざりさせるもの,やっかい者 / (肉体的・精神的に)…‘に'苦痛を与える(受動態にできない)
(ふた付きのじょうぶな)『大箱』,ひつ / 《米》たんす(=chest of drawers) / (…の)たんすいっぱい《+『of』+『名』》 / 『胸[部]』,肺
心臓の
《補語にのみ用いて》腹を立てて / 《補語にのみ用いて》(心が)鐘ついて / 不愉快な,気まずい

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/17 16:27:09」(JST)

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Chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain.

Differential diagnosis

Causes of chest pain range from non-serious to serious to life threatening.^[1] DiagnosisPro lists more than 440 causes on its website.^[2]

Cardiovascular

Acute coronary syndrome
- Unstable Angina Pectoris - requiring emergency medical treatment but not primary intervention as in a myocardial infarction.
- Myocardial infarction ("heart attack")^[3]
Aortic dissection
Pericarditis and cardiac tamponade
Arrhythmia - atrial fibrillation and a number of other arrhythmias can cause chest pain.
Stable angina pectoris - this can be treated medically and although it warrants investigation, it is not an emergency in its strictest sense
Myocarditis
Mitral valve prolapse syndrome
Aortic aneurysm

Respiratory

Pulmonary embolism
Pneumonia
Hemothorax
Pneumothorax and Tension pneumothorax
Pleurisy - an inflammation which can cause painful respiration
Tuberculosis
Tracheitis
Lung malignancy

Gastrointestinal

Gastroesophageal reflux disease (GERD) and other causes of heartburn
Hiatus hernia
Achalasia, nutcracker esophagus and other neuromuscular disorders of the esophagus
Functional dyspepsia

Chest wall

Costochondritis or Tietze's syndrome - a benign and harmless form of osteochondritis often mistaken for heart disease
Spinal nerve problem
Fibromyalgia
Chest wall problems
Radiculopathy
Precordial catch syndrome - another benign and harmless form of a sharp, localised chest pain often mistaken for heart disease
Breast conditions
Herpes zoster commonly known as shingles
Tuberculosis
Osteoarthritis
Bornholm disease

Psychological

Panic attack
Anxiety
Clinical depression
Somatization disorder
Hypochondria

Others

Hyperventilation syndrome often presents with chest pain and a tingling sensation of the fingertips and around the mouth
Da costa's syndrome
Carbon monoxide poisoning
Sarcoidosis
Lead poisoning
High abdominal pain may also mimic chest pain
Prolapsed intervertebral disc
Thoracic outlet syndrome

Diagnostic approach

History taking:

Knowing a patient's risk factors can be extremely useful in ruling in or ruling out serious causes of chest pain. For example, heart attack and thoracic aortic dissection are very rare in healthy individuals under 30 years of age, but significantly more common in individuals with significant risk factors, such as older age, smoking, hypertension, diabetes, history of coronary artery disease or stroke, positive family history (premature atherosclerosis, cholesterol disorders, heart attack at early age), and other risk factors.

Physical examination:

In the emergency department the typical approach to chest pain involves ruling out the most dangerous causes: heart attack, pulmonary embolism, thoracic aortic dissection, esophageal rupture, tension pneumothorax and cardiac tamponade. By elimination or confirmation of the most serious causes, a diagnosis of the origin of the pain may be made. Often, no definite cause will be found and reassurance is then provided.^[1]

If acute coronary syndrome ("unstable angina") is suspected, many people are admitted briefly for observation, sequential ECGs, and determination of cardiac enzymes over time. On occasion, further tests on follow up may determine the cause. TIMI score performed at time of admission may help stratify risk. Features of the pain suggestive of cardiac ischaemia are describing the pain as heaviness; radiation of the pain to the neck, jaw or left arm; sweating; nausea; palpitations; the pain being felt upon exertion; dizziness; shortness of breath; and a "sense of impending doom."

Careful medical history and physical examination is essential in separating dangerous from trivial causes of disease, and the management of chest pain may be done on specialised units (termed medical assessment units) to concentrate the investigations. Occasionally, invisible medical signs will direct the diagnosis towards particular causes, such as Levine's sign in cardiac ischemia. A rapid diagnosis can be life-saving and often has to be made without the help of medical tests, however, additional tests are generally required to establish the diagnosis.

Medical tests:

On the basis of the above, a number of tests may be ordered:^[4]

X-rays of the chest and abdomen . Routine X-rays however are not needed.
CT scanning may be used in unexplained chest pain when other tests are inconclusive.
An electrocardiogram (ECG)
V/Q scintigraphy or CT pulmonary angiogram(when a pulmonary embolism is suspected)
Blood tests:
- Complete blood count
- Electrolytes and renal function (creatinine)
- Liver enzymes
- Creatine kinase (and CK-MB fraction in many hospitals)
- Troponin I or T (to indicate myocardial damage)
- D-dimer (when suspicion for pulmonary embolism is present but low)
- serum lipase to exclude acute pancreatitis

Management

In people with chest pain supplemental oxygen is not needed unless the oxygen saturations are less than 94% or there are signs of respiratory distress.^[5]^[6] Entonox is frequently used by EMS personnel in the prehospital environment.^[7] There is however little evidence about its effectiveness.^[8]^[6]

Epidemiology

Chest pain is the presenting symptom in about 12% of emergency department visits in the United States and has a one year mortality of about 5%.^[9]

References

^ ^a ^b Woo KM, Schneider JI (November 2009). "High-risk chief complaints I: chest pain--the big three". Emerg. Med. Clin. North Am. 27 (4): 685–712, x. doi:10.1016/j.emc.2009.07.007. PMID 19932401.
^ "Differential Diagnosis For Chest Pain: Poisoning (Specific Agent)".
^ Mallinson, T (2010). "Myocardial Infarction". Focus on First Aid (15): 15. Retrieved 2010-06-08.
^ Hess EP, Perry JJ, Ladouceur P, Wells GA, Stiell IG (March 2010). "Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome". CJEM 12 (2): 128–34. PMID 20219160.
^ "Highlights of the 2010 AHA Guidelines for CPR and ECC". American Heart Association.
^ ^a ^b O'Connor, RE; Brady, W, Brooks, SC, Diercks, D, Egan, J, Ghaemmaghami, C, Menon, V, O'Neil, BJ, Travers, AH, Yannopoulos, D (2010-11-02). "Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 122 (18 Suppl 3): S787–817. doi:10.1161/CIRCULATIONAHA.110.971028. PMID 20956226.
^ Castle, N (2003 Feb). "Effective relief of acute coronary syndrome". Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association 10 (9): 15–9. PMID 12655961.
^ "Entonox for the Treatment of Undiagnosed Chest Pain: Clinical Effectiveness and Guidelines". Canadian Agency for Drugs and Technologies in Health. Retrieved 12 July 2011.
^ Stephen J. Dubner; Steven D. Levitt (2009). SuperFreakonomics: Tales of Altruism, Terrorism, and Poorly Paid Prostitutes. New York: William Morrow. p. 77. ISBN 0-06-088957-8.

UpToDate Contents

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1. Outpatient evaluation of the adult with chest pain
2. Evaluation of the adult with chest pain of esophageal origin
3. Nontraumatic chest pain in children and adolescents: Approach and initial management
4. 成人における筋骨格系の胸痛の主な原因 major causes of musculoskeletal chest pain in adults
5. 筋骨格系の胸痛の臨床的評価 clinical evaluation of musculoskeletal chest pain

English Journal

Cost and outcomes of assessing patients with chest pain in an Australian emergency department.

Cullen L1, Greenslade J2, Merollini K2, Graves N2, Hammett CJ3, Hawkins T3, Than MP4, Brown AF3, Huang CB5, Panahi SE5, Dalton E3, Parsonage WA3.
The Medical journal of Australia.Med J Aust.2015 May 4;202(8):427-32.
OBJECTIVES: We sought to characterise the demographics, length of admission, final diagnoses, long-term outcome and costs associated with the population who presented to an Australian emergency department (ED) with symptoms of possible acute coronary syndrome (ACS).DESIGN, SETTING AND PARTICIPANTS:
PMID 25929506

Non-cardiac chest pain: a clinical assessment tool.

Lanham DA1, Taylor AN, Chessell SJ, Lanham JG.
British journal of hospital medicine (London, England : 2005).Br J Hosp Med (Lond).2015 May;76(5):296-300. doi: 10.12968/hmed.2015.76.5.296.
A simple clinical approach to patients presenting with chest pain is outlined, which is easily taught and can be quickly applied. This approach was demonstrated in a large cohort of patients and this article discusses the characteristics of the various diagnostic sub-groups.
PMID 25959942

Characteristics and mid-term follow-up of a single-center population affected by Tako-Tsubo cardiomyopathy.

Vizzardi E1, Bonadei I, Rovetta R, Sciatti E, D'Aloia A, Pezzali N, Salghetti F, Curnis A, Metra M.
Journal of cardiovascular medicine (Hagerstown, Md.).J Cardiovasc Med (Hagerstown).2015 May;16(5):326-30. doi: 10.2459/JCM.0b013e328364e710.
INTRODUCTION: Tako-Tsubo cardiomyopathy (TTC) is an acute cardiomyopathy mimicking acute myocardial infarction. The aim of our study was to define clinical and instrumental features of an Italian population of patients with TTC and to report their short and mid-term outcome.METHODS: We retrospective
PMID 25822333