Chest pain (chest pain) is a common clinical symptom, mainly caused by chest diseases, a few of which are caused by other diseases. The degree of chest pain varies according to the difference of individual pain threshold and is not completely consistent with the degree of severity of the disease. Etiology and mechanism of occurrence The causes of chest pain are mainly thoracic diseases, the common ones are: 1, chest wall diseases Acute dermatitis, subcutaneous cellulitis, herpes zoster, intercostal neuritis, costochondritis, epidemic myositis, rib fracture, multiple myeloma, acute leukemia, etc. 2.Cardiovascular diseases Coronary atherosclerotic heart disease (angina pectoris, myocardial infarction), cardiomyopathy, mitral or aortic valve lesions, acute pericarditis, thoracic aortic aneurysm (entrapment aneurysm), pulmonary infarction, pulmonary hypertension and neuropathy. 3.Respiratory system diseases Pleurisy, pleural tumor, spontaneous pneumothorax, hemothorax, bronchitis, bronchopulmonary cancer, etc. 4.Mediastinal diseases Mediastinitis, mediastinal emphysema, mediastinal tumor, etc. 5.Other Hyperventilation syndrome, gout, esophagitis, esophageal cancer, esophageal hiatal hernia, subdiaphragmatic abscess, liver abscess, splenic infarction, etc. Various chemical, physical factors and stimulation factors can stimulate sensory nerve fibers in the chest to produce nociceptive impulses and transmit to the nociceptive center of the cerebral cortex to cause chest pain. The sensory nerve fibers in the chest are: (1) intercostal nerve sensory fibers; (2) sympathetic nerve fibers innervating the aorta; (3) vagus nerve fibers innervating the trachea and bronchi; and (4) sensory fibers of the phrenic nerve. In addition, in addition to the local pain of the diseased organ, there is also pain in the body surface or deep tissues far from the organ, called radiating pain or involvement pain. The reason for this is that the afferent nerve of the visceral lesion and the corresponding area of the body surface enter the same segment of the spinal cord and are connected in the posterior horn, so the sensory impulses from the visceral area can directly excite the sensory nerve origin of the body surface of the spinal cord, causing pain in the original area of the corresponding body surface. For example, in angina pectoris, in addition to the precordial region and retrosternal pain, it may also radiate to the left shoulder, left inner arm or left neck and left cheek. Clinical manifestations 1. Age of onset Chest pain in young adults is mostly considered tuberculous pleurisy, spontaneous pneumothorax, myocarditis, cardiomyopathy, rheumatic heart valve disease, while angina pectoris, myocardial infarction and bronchopulmonary carcinoma should be paid attention to over 40 years old. For example, chest pain caused by chest wall diseases is often fixed at the lesion site, and there is local pressure pain, if it is an inflammatory lesion of the chest wall skin, there can be local redness, swelling, heat and pain; chest pain referred to by herpes zoster can be seen as clusters of blisters distributed along one side of the intercostal nerve with severe pain, and the herpes does not exceed the midline of the body; chest pain caused by costochondritis is often found in the first The pain of angina pectoris and myocardial infarction is mostly in the posterior sternum and precordial region or under the glabella, and may radiate to the left shoulder and left inner arm, or even to the ring finger and little finger, or to the left neck or cheek, mistaking it for toothache; the pain of entrapment aneurysm is mostly in the thoracic back, radiating downward to the lower abdomen, lumbar region and both groins and lower limbs. Pleurisy causes pain mostly in the lateral part of the chest; esophageal and mediastinal lesions cause chest pain mostly in the posterior sternum; hepatobiliary diseases and subdiaphragmatic abscesses cause chest pain mostly in the right lower chest, and the pain radiates to the right shoulder when it invades the central part of the diaphragm; apical lung cancer (supraglottic sulcus, Pancoast carcinoma) causes pain mostly in the shoulder and axilla, and radiates to the inner part of the upper limbs. 3.Nature of chest pain The degree of chest pain can be severe, mild or hidden. The nature of chest pain can be various. For example, herpes zoster is a sharp pain like cutting or burning; esophagitis is mostly burning pain. Intercostal neuralgia is paroxysmal burning pain or stabbing pain; angina pectoris is cramp-like pain with heavy pressure and suffocation, while myocardial infarction is more intense pain with fear and near-death feeling; pneumothorax has tear-like pain at the early stage of onset; pleurisy often presents vague pain, dull pain and stabbing pain; entrapment aneurysm often presents sudden onset of severe pain or cone pain in the back of the chest; pulmonary infarction can also occur suddenly with severe pain or colic in the chest, often accompanied by dyspnea and cyanosis. 4.Pain duration The pain caused by smooth muscle spasm or ischemia of blood vessel stenosis is paroxysmal, while the pain caused by inflammation, tumor, embolism or infarction is persistent. For example, angina pectoris episodes are brief (lasting 1-5 minutes), while myocardial infarction pain lasts for a long time (several hours or longer) and is not easily relieved. For example, an angina attack can be triggered by exertion or mental stress and relieved within 1-2 minutes after rest or after taking nitroglycerin or isosorbide nitrate, while the pain caused by myocardial infarction is not effective when taking the upper medicine. Oesophageal disease mostly attacks or intensifies when eating, and can be reduced or disappeared with antacids and prokinetic drugs. Chest pain in pleurisy and pericarditis may be aggravated by coughing or forceful breathing. Accompanying symptoms 1. Chest pain with cough, sputum and/or fever is commonly associated with tracheal, bronchial and pulmonary diseases. 2. Chest pain with dyspnea often indicates a large extent of lesion involvement, such as lobar pneumonia, spontaneous pneumothorax, exudative pleurisy and pulmonary embolism, etc. 3, chest pain with hemoptysis is mainly seen in pulmonary embolism, bronchopulmonary cancer. 4.Chest pain with pallor, profuse sweating, decreased blood pressure or shock is mostly seen in myocardial infarction, coarcted aneurysm, ruptured aortic sinus aneurysm and massive pulmonary embolism. 5, chest pain with dysphagia Mostly suggest esophageal diseases, such as reflux esophagitis, etc. General information includes age of onset, urgency of onset, causative factors, aggravation and relief. 2. Chest pain manifestations including location, nature, degree, duration and presence of radiating pain. 3.Concomitant symptoms include respiratory, cardiovascular, digestive system and other system symptoms and degree. The four most critical differential diagnoses are 1. acute myocardial infarction 2. acute pericarditis 3. aortic coarctation 4. pulmonary infarction