Introduction
Chest Pain is a common clinical symptom that may or may not have significant clinical implications.
Clinical features (wth differential diagnoses)
- Sharp, lancinating lateral chest pain, worse with breathing and coughing: pleurisy
- Dull aching lateral chest pain: chest wall pain, pleural effusion
- Central chest pain precipitated by a dry harking cough: suggestive of tracheitis or tracheobronchitis
- Central chest discomfort/pain with
sensation of heaviness or chest compression: suggestive of myocardial ischaemia - Lateral burning chest pain associated with tenderness on physical contact: Bornholm’s disease
Investigations
- Chest radiography
- Electrocardiography
- Echocardiography
Treatment objectives
- Treat primary cause Relieve pain
Drug treatment
Non narcotic analgesics
Paracetamol
Adult:
- 1 g orally every 8 hours
Child:
- 1-3 months: 30-60 mg every 8 hours
- 3-12 months: up to 120 mg every 4-6 hours
- 1-5 years: 120 -250 mg every 4 – 6 hours
- 6- 12 years: 250-500 mg every 4-6 hours;
- 12 – 18 years: 500 mg every 4-6 hours
Non-steroidal analgesics
Diclofenac sodium
Adult:
- 25-50 mg orally three times (daily depending on severity)
Child:
- 6 months-18years: 0.31 mg/kg by mouth or by rectum 3 times daily (maximum total dose 150 mg daily)
Pain of more serious aetiology e.g. pain of lower or upper respiratory tract infection, or pain of myocardial ischaemia – Refer to an appropriate specialist