Sharp stabbing pain in chest
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Understanding Sharp Stabbing Chest Pain: Causes and Diagnosis
Pleuritic Chest Pain and Pulmonary Embolism
Pleuritic chest pain is a sudden, intense sharp, stabbing, or burning pain in the chest that occurs during inhalation and exhalation. One of the most serious causes of pleuritic chest pain is pulmonary embolism, which is found in 5% to 21% of patients presenting to emergency departments with this symptom. To diagnose pulmonary embolism, clinicians often use validated clinical decision rules and additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography.
Postoperative Pain Following Thoracotomy
Patients who have undergone thoracotomy often experience sharp, stabbing pain at the incision site, particularly in the first 48 hours postoperatively. This pain is exacerbated by movement, breathing, coughing, and other activities. Effective pain management strategies include physical interventions such as applying pressure to the painful area and engaging in conversations about pain relief.
Sternal Wire Sutures and Chest Wall Pain
Sternal wire sutures can cause disabling chest wall pain, described as sharp and stabbing, occurring months after a median sternotomy. This pain is often due to an exaggerated fibrous tissue reaction around the twisted portion of the wires, which can entrap sensory nerve fibers. Removal of the involved wires and surrounding fibrous tissue typically relieves the pain.
Chest Pain in Acute Asthma
During acute asthma attacks, patients frequently report sharp, stabbing chest pain in the sternal or subcostal areas. This pain is often worsened by coughing, deep inspiration, or movement and can be quite severe. Although this type of chest pain is usually benign and self-limiting, it can cause significant distress and diagnostic confusion.
Histoplasmosis and Chest Pain
In rare cases, histoplasmosis can present with sharp, stabbing chest pain. For instance, an 11-year-old girl experienced such pain, which was intermittently pleuritic and radiated to her left arm. Her condition was eventually diagnosed as histoplasmosis, confirmed by biopsy and urine antigens, and treated with steroids and itraconazole, leading to symptom improvement.
Post-Coronary Artery Bypass Pain
Patients may experience sharp, stabbing chest pain weeks after a successful coronary artery bypass surgery. This pain can be resistant to various pain management strategies but may respond to specific medications like mexilitine, which can alleviate the pain within a few weeks.
Identifying Low-Risk Patients in the Emergency Room
In the emergency room, identifying low-risk patients with chest pain can be challenging. A combination of factors such as sharp or stabbing pain, no history of angina or myocardial infarction, and pain with pleuritic or positional components can help define a very-low-risk group. However, these patients are a small subset, and careful consideration of history, physical examination, and ECG findings is essential.
Traumatic Ventricular Septal Defect
A traumatic ventricular septal defect (VSD) can result from penetrating cardiac injuries, leading to sharp, persistent chest pain. Diagnosis is confirmed through imaging techniques such as echocardiography, which reveals abnormalities like pulmonary trunk dilation and ventricular septal defects. Surgical intervention is often required to address the underlying injury and alleviate the pain.
Conclusion
Sharp, stabbing chest pain can arise from various conditions, ranging from pulmonary embolism and postoperative complications to acute asthma and rare infections like histoplasmosis. Accurate diagnosis and appropriate treatment are crucial for managing this symptom effectively. Understanding the underlying causes and employing validated clinical decision rules can help clinicians provide optimal care for patients experiencing this type of chest pain.
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