i bc27f85be50b71b1 (285 page)

x

Physical Therapy Considerations

for Patients Who Complain

of Chest Pain

Michele P. West

The purpose of this appendix is to discuss the different etiologies of

cardiogenic and noncardiogenic chest pain and provide a means of

raking an efficient history when a patient complains of chest pain.

Chest pain is a common complaint for which many patients seek

medical attention.

Cardiogenic chest pain may be ischemic or nonischemic. Ischemic

chest pain may be caused by atherosclerosis, coronary spasm, systemic

or pulmonary hypertension, aortic stenosis, hypertrophic cardiomyopathy, severe anemia or hypoxia, or polycythemia, I Nonischemic chest pain may be owing to aortic dissection or aneurysm, pericarditis, mjtral

valve prolapse, or myocarditis. J (Refer to Figure 1-8 for the possible

clinical courses of patients admitted with cardiogenic chest pain.)

Noncardiogenic chest pain can arise from a wide range of diseases

and disorders as described in Table X-I, each with its own distinctive

associated signs and symptoms. Refer to Table 8-1 for gastrointestinal

pain referral patterns. Very commonly, the patient rationalizes chest

pain as a gastrointestinal disturbance rather than angina.

921

922 AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table X-1. Possible Etiologies and Associated Signs of

Noncardiogenic Chest Pain

Origin

Possible Etiology

Signs and Symptoms

Pulmonary

Pneumonia

Abnormal breath sounds

Pulmonary embolism

and respiratory rate)

Tuberculosis

presence of cough or

hemoptysis

Pleural

Pleuritis

Pain with respiration,

Pneumothorax

pleural rub, abnormal

Mediastinitis

breath sounds and

respiratory rate

Gastrointestinal

Hiatal hernia

Nausea, vomiting,

Esophagitis

burping, abdominal

Esophageal reflux

pain

Acute pancreatitis

Musculoskeletal

Muscle strain

Reproduction of pain

Repetitive coughing

with palpation and

Rib fracture(s)

pain with respiration

or cough

Sources: Data from NH Holmes, M Foley, I'H Thompson (cds). Profcssional Guide to

Signs and Symproms (3rd cd). Springhouse, PA: Springhouse. 1997;1 53j and RL

Wilkins, SJ Kridcr, RL Sheldon (eds). Clinical Assessment in Respiratory Care (3rd ed).

St. Louis: Mosby, 1995;28.

Chest pain can present with signs and symptoms other than the

classic angina pectoris owing to myocardial ischemia. The mnemonic

OLD CARTcan be used as a rapid survey for the differential diagnosis of chest pain during a physical therapy session '-3: Onset-Sudden versus insidious, with exertion or stress versus rest?

(Cardiogenic chest pain is usually of sudden onset.)

Location-Substernal or on the left side of the chest? (Cardiogenic

chest pain typically occurs in this location, but can 21so present in