Pain in chest and back
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Understanding Chest and Back Pain: Causes and Diagnostic Approaches
Chest and back pain are common symptoms that can arise from a variety of underlying conditions. This article synthesizes recent research to provide a comprehensive overview of the potential causes and diagnostic strategies for these symptoms.
Acute Aortic Syndrome and Aortic Dissection
Acute Aortic Syndrome
Acute aortic syndrome (AAS) can present with symptoms similar to acute coronary syndrome and pulmonary embolism, but it requires different management strategies. A case study highlighted a 59-year-old female with latent tuberculosis and chronic back pain who presented with pleuritic chest pain, underscoring the complexity of diagnosing AAS.
Aortic Dissection
Aortic dissection is a critical condition that often presents with severe chest pain radiating to the back. It is more common in men aged 55-65 and requires immediate medical attention. A case involving a 55-year-old man with hypertension and a history of smoking demonstrated the urgency of diagnosing and treating this condition, as initial tests may not always reveal abnormalities. Another case of a 26-year-old male with sudden severe chest pain radiating to the upper back, described as a tearing sensation, further illustrates the presentation of aortic dissection.
Spondyloarthritis and Anterior Chest Wall Pain
Spondyloarthritis
Spondyloarthritis (SpA) is associated with inflammatory back pain and can lead to anterior chest wall (ACW) pain. Research from the DESIR cohort found that ACW pain is prevalent in patients with early inflammatory back pain suggestive of SpA. This pain is often linked with enthesitis, thoracic spine involvement, and radiographic abnormalities of the sacroiliac joints, indicating a more severe disease course.
Diagnostic Approaches for Chest and Back Pain
Physical Examination Tests
A systematic review investigated the use of physical examination tests (PETs) for screening serious pathologies in patients with chest and back pain. The review highlighted the variability in PET utilization among healthcare professionals, with cardiac and pulmonary auscultation being the most frequently reported tests. The study emphasized the need for consistent and thorough examination practices to ensure accurate diagnosis and appropriate referrals.
Clinical Practice Guidelines
The 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline provides a structured approach for evaluating and diagnosing chest pain. This guideline recommends evidence-based risk stratification and diagnostic workup, incorporating cost-value considerations and shared decision-making with patients.
Other Considerations
Thoracalgia
Thoracalgia, or chest pain accompanied by muscle tension in the back and neck, is a common issue in clinical practice. It can be challenging to diagnose due to the potential overlap with symptoms of other conditions, such as heart disease. A systemic analysis of literature data underscores the importance of accurate diagnosis and appropriate treatment to manage thoracalgia effectively.
Case Studies
Various case studies illustrate the diverse presentations of chest and back pain. For instance, a 22-year-old man with back pain, dilated veins over the chest, and a mass in the right atrium presented with symptoms that required careful evaluation to determine the underlying cause. Another case involved a 52-year-old man who experienced severe chest pain after eating, highlighting the need for differential diagnosis in such scenarios.
Conclusion
Chest and back pain can result from a range of serious conditions, including acute aortic syndrome, aortic dissection, and spondyloarthritis. Accurate diagnosis requires a thorough understanding of the potential causes and the use of appropriate diagnostic tests. Adhering to clinical guidelines and employing a systematic approach to physical examinations can help healthcare professionals manage these symptoms effectively and ensure timely treatment for patients.
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