Chest Pain

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