Pain in chest and in back
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Summary
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Some studies suggest that chest and back pain can be indicative of serious conditions like aortic dissection or acute aortic syndrome, while other studies highlight musculoskeletal issues or inflammatory back pain as potential causes.
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Understanding Chest and Back Pain: Causes and Diagnostic Approaches
Common Causes of Chest and Back Pain
Aortic Dissection
Aortic dissection is a critical condition that requires immediate medical attention. It often presents with severe chest pain radiating to the back, described as a tearing sensation. This condition is more common in men aged 55-65 and can be life-threatening if not promptly treated . Symptoms may include sudden onset chest pain, syncope, and physical signs such as a widened mediastinum on chest x-ray.
Spondyloarthritis and Anterior Chest Wall Pain
In patients with inflammatory back pain suggestive of spondyloarthritis (SpA), anterior chest wall (ACW) pain is a significant symptom. ACW pain is associated with enthesitis, thoracic spine involvement, and radiographic abnormalities of the sacroiliac joints. It is prevalent in about 44.6% of patients with early SpA and can indicate a more severe disease course.
Musculoskeletal Disorders
Musculoskeletal issues are a recognized source of chest pain, often underdiagnosed and untreated. Conditions such as Tietze syndrome, costochondritis, and segmental dysfunction of the cervical and thoracic spine can cause significant discomfort. These conditions, although benign, can lead to chronic pain and disability if not properly managed.
Diagnostic Approaches
Physical Examination Tests (PETs)
Physical examination tests are crucial for screening serious pathologies in patients with chest or back pain. Commonly used tests include cardiac and pulmonary auscultation, lung percussion, and costovertebral angle tenderness. However, the utilization of these tests varies among healthcare professionals, with doctors and nurses less frequently assessing the range of motion of the thoracolumbar spine and hip.
Imaging and Laboratory Tests
For conditions like aortic dissection, imaging such as computed tomography (CT) scans of the chest and abdomen are essential for diagnosis. Initial blood investigations, including cardiac enzymes, may not always indicate the severity of the condition, making imaging a critical component of the diagnostic process .
Clinical Practice Guidelines
The 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guidelines provide a comprehensive approach to the evaluation and diagnosis of chest pain. These guidelines recommend an evidence-based approach to risk stratification and diagnostic workup, emphasizing the importance of cost-value considerations and shared decision-making with patients.
Conclusion
Chest and back pain can arise from various serious conditions, including aortic dissection, spondyloarthritis, and musculoskeletal disorders. Accurate diagnosis through physical examination tests, imaging, and adherence to clinical guidelines is essential for effective management and treatment. Understanding the diverse causes and appropriate diagnostic approaches can significantly improve patient outcomes.
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