He suspects something is seriously wrong, and he trusts your opinion
He suspects something is seriously wrong, and he trusts your opinion. half the individuals with undiagnosed chest pain, symptoms are caused by gastroesophageal disease. Empirical acid-suppressive therapy having a proton pump inhibitor can assist clinicians m-Tyramine hydrobromide in identifying individuals whose symptoms are acid-related. Summary Many individuals with undiagnosed chest pain can be handled in primary care, minimizing the need for referrals and expensive investigations. RSUM OBJECTIF Mettre en vidence que le reflux gastro-?sophagien est une cause frquente de douleur thoracique dtiologie indtermine. SOURCES DE LINFORMATION Les considrations dordre diagnostique proviennent darticles rviss par des pairs recenss dans MEDLINE. Les tudes devaient tre en anglais et porter sur au moins 30 sujets. Dans les tudes dmographiques, la taille des chantillons devait tre dau moins 300 et le taux de rponse dau moins 60%. Trente-sept content articles pertinents ont t retenus. PRINCIPAL MESSAGE Chez un patient qui prsente une douleur thoracique dorigine incertaine, on doit dabord rechercher soigneusement une maladie coronarienne ou toute autre cause potentielle de mort. Linvestigation doit se poursuivre jusqu ce quon ait identifi la maladie causale et obtenu un contr?le adquat des sympt?mes. Des douleurs thoraciques dtiologieindtermine entra?nent la longue dimportantes souffrances, une perte de qualit de vie et des co?ts inutiles pour le m-Tyramine hydrobromide systme de sant. Dans plus de la moiti des cas de douleur thoracique non diagnostique, les sympt?mes sont causs par le reflux gastro-?sophagien. Un traitement empirique dinhibition de la scrtion acide par un inhibiteur de la pompe protons peut aider le mdecin identifier les individuals dont les sympt?mes sont relis lacidit. Summary Plusieurs individuals prsentant des douleurs thoraciques dorigine indtermine peuvent tre characteristics adquatement en soins de premire ligne, rduisant ainsi le recours des consultations ou investigations co?teuses. This short article presents an approach to management of undiagnosed chest pain, focusing on the importance of gastroesophageal reflux disease (GERD) once physicians have identified that cardiac causes are unlikely. The management strategy is based on a m-Tyramine hydrobromide evaluate of the literature by a group of experienced family physicians, a gastroenterologist, and a cardiologist. By using this management plan, family physicians can handle most instances. Bobs case Bob, a stressed entrepreneur with unexplained chest pain, is definitely a 48-year-old businessman having a sedentary lifestyle (Table 1). He is increasingly troubled by chest pain that started more than a 12 months ago and is getting more frequent as his work stress increases. He came to the emergency ward recently with a particularly severe episode of chest pain. After performing the usual cardiac checks, the emergency physician and the cardiologist concluded Rabbit Polyclonal to RBM34 that there was a low probability of symptomatic coronary artery disease and recommended Bob to visit his family doctor. Bob offers made an appointment to talk to you. He remains concerned because he continues to experience chest pain and has not been given an explanation for his symptoms. He suspects something is definitely seriously wrong, and he trusts your opinion. What will you are doing? Table 1 Case profile illness?Herpes?Irradiation-induced pain?Esophageal foreign body?Peptic ulcer disease?Pancreatitis?Biliary disease?Splenic infarction?Gaseous bowel distentionNEUROMUSCULOSKELETAL CAUSES?Thoracic outlet syndrome?Anterior scalenus hypertrophy?Cervical rib syndrome?Cervical disc disease?Costochondritis or Tietzes syndrome? Chest wall stress or rib fracture?Malignancy?Herpes zoster?Precordial catch syndrome?Entrapment of nerves by sternal wire sutures?Xiphodynia?Slipping rib syndrome?Ostealgia due to neoplasm?Intercostal neuritis?Costovertebral joint dysfunctionPULMONARY CAUSES?Pulmonary embolism?Pneumothorax?Pneumonia?Pleuritis?Bronchospasm?Pulmonary hypertension?Tracheitis or tracheobronchitis?Intrathoracic tumourPSYCHIATRIC CAUSES?Major depression?Anxiety?Panic attacks?MalingeringOTHER CAUSES?Cocaine use?Lymphoma?Diabetes?Uremia?Renal stones?Mondors syndrome?Mediastinitis?Mediastinal emphysema?Mediastinal neoplasm Open in a separate window Careful assessment of patients history is often the most helpful starting point. Historic features generally of very best value include the quality, period, and timing of pain, as well as its association with.
