chest pain [AS, cest, box; L, poena, punishment] , a physical complaint that requires immediate diagnosis and evaluation. Chest pain may be symptomatic of cardiac disease, such as angina pectoris, myocardial infarction, aortic stenosis, or pericarditis, or of pulmonary disease, such as pleurisy, pneumonia, or pulmonary embolism or infarction. The source of chest pain may also be musculoskeletal, gastrointestinal, or psychogenic. The use of illegal drugs such as cocaine may also cause chest pain. Over 90% of severe chest pain in adults is caused by coronary disease, spinal root compression, or psychological disturbance. ▪ OBSERVATIONS: Evaluation of chest pain requires determining the quality of the pain (dull, sharp, or crushing), locating the site of the pain (in the center or side of the chest), and determining how long the pain has persisted, how it has developed, and whether it has occurred in the past. The patient is asked to describe the spread of pain to other parts of the body and to identify such factors as exertion, emotional distress, movement, eating, or deep breathing that aggravate or relieve the pain. If the pain is reproducible by palpation during physical examination, it is unlikely to be cardiac in origin. ▪ PATIENT CARE CONSIDERATIONS: Because of its association with life-threatening heart disease, chest pain causes extreme anxiety, which tends to mask other symptoms that would aid in diagnosis and treatment. Reassuring the person being examined assists in proper diagnosis. Other specific cardiovascular conditions associated with chest pain are myocardial infarction, angina pectoris, pericarditis, and a dissecting aneurysm of the thoracic aorta. Musculoskeletal conditions include rib fractures, swelling of the rib cartilage, and muscle strain. GI conditions associated with chest pain include esophagitis, peptic ulcers, hiatal hernia, gastritis, cholecystitis, and pancreatitis.
