看胸痛别在心内科扎堆儿

看Chest pain别在心内科扎堆儿

　　胸痛在各个年龄人群中均可出现。很多人胸口稍有不适，就忧心忡忡，担心自己得了严重的心脏病，赶紧到心血管内科就医。在门诊，笔者也常常碰到很多不属于心内科诊治范围的胸痛病人。事实上，胸痛的部位和严重程度，并不一定和病变的部位与严重程度相一致。其他部位的器质性疾病、精神因素等都可能引起胸痛。不同性质的胸痛预示不同的疾病，患者可初步判断后再决定去不同的专科诊治，以免耽搁时间，延误病情。

Chest pain在各个年龄人群中均可出现.A lot of people a slight chest,Just worried about,Worried that you have serious heart disease,Hurry to cardiovascular internal medicine doctor.In the clinic,The author also often encounter a lot do not belong to the scope of heart medicine diagnosis and treatment of chest pain patients.In fact,,The part of the chest pain and severity,Does not necessarily and lesion area and extent.Other parts of the organic disease/精神因素等都可能引sinceChest pain.Different properties indicate different diseases of chest pain,Patients can preliminary judgment before deciding to go to different specialist treatment,So as not to delay the time,Delay of the illness.

　　看心脏内科 心前区或胸骨后压榨性疼痛，常在劳累、紧张、受凉时发生，如冬季外出、饱餐后散步、匆忙赶路、走上坡路、上楼梯及用力大便时，每次发作几分钟至十余分钟不等，可向颈部、咽喉、下颌、上腹部、左肩或左臂内侧放射，休息或含服硝酸甘油可以缓解。这大多是心脏缺血的表现，需要去心内科就诊。急性心包炎的疼痛常位于心前区，可随呼吸、咳嗽、体位的变化而变化，并伴有放射痛、发热等，需要看心内科。心肌病如扩张型心肌病、肥厚型心肌病；心脏瓣膜疾病，如二尖瓣狭窄或脱垂、主动脉狭窄及关闭不全也可引起类似心肌缺血的胸痛，需看心内科或心外科。

看心脏内科 心前区或胸骨后压榨性疼痛,Often in overworked/nervous/Occurs when catch cold catch cold,As winter on/A walk after meal/Hurry hurry/Out of difficulty/Up the stairs and forcibly defecate,Attack for a few minutes to more than 10 minutes at a time,To the neck/The throat/The jaw/Upper abdomen/Left shoulder and left arm inside,Rest or containing nitroglycerin can relieve.This is mostly cardiac ischemia,Need to go to the heart medicine clinic.Acute pericarditis is often located in the area before the heart pain,With the breath/Have a cough/Changes in body position,Accompanied by pain/Fever, etc.,Need to see heart medicine.Cardiomyopathy DCM/Hypertrophic cardiomyopathy;Heart valve diseases,Such as mitral stenosis or prolapse/主动脉狭窄及关闭不全也可引since类似心肌缺血的Chest pain,Need to see heart or with cardiac surgery.

　　看急诊内科 胸痛剧烈且不能缓解，伴有濒死感、恐惧感，需要去急诊内科就诊，排除急性心肌梗死。胸痛剧烈，由前胸转向后背，或由上胸转移至下胸部或腹部，需要排除急性主动脉夹层或主动脉壁内血肿。胸痛剧烈伴有咯血、呼吸困难应去急诊内科就诊，排除肺动脉栓塞的可能。

看急诊内科 Severe chest pain且不能缓解,Accompanied by dying/fear,Need to go to the emergency department physician visits,Rule out acute myocardial infarction.Severe chest pain,From the chest to back,Or by the chest to chest or abdomen,Need to rule out acute aortic dissection or aortic intramural hematoma.Severe chest pain associated with hemoptysis/Dyspnea should go to emergency medicine doctor,Rule out the possibility of pulmonary embolism.

　　看急诊外科 外伤后，胸痛剧烈不能缓解，伴有呼吸困难，要考虑有无肋骨骨折、血气胸或张力性气胸等，建议看急诊外科。

看急诊外科 trauma后,Severe chest pain relief,Accompanied by shortness of breath,To consider any rib fractures/Hemopneumothorax or tension pneumothorax,Suggest the emergency surgery.

　　看呼吸科、胸外科、肿瘤科 胸痛伴有咳嗽、咯血，深吸气或呼气时加重，多为气管、支气管、胸膜、肺部疾病，如胸膜炎、自发性气胸、肺结核、肺炎、肺肿瘤等，建议去呼吸科或胸外科就诊。食道裂孔疝也可表现为胸骨后疼痛，其特点是卧位时症状加重，建议看胸外科。纵隔肿瘤压迫神经、胸椎、肋骨，产生持续性疼痛并伴有呼吸困难、咳嗽、声嘶等，建议看胸外科或肿瘤科。

看呼吸科/Thoracic surgery/Oncology department of chest pain associated with cough/hemoptysis,Deep inhale or exhale,More for the trachea/bronchial/The pleura/Lung disease,If pleurisy/Spontaneous pneumothorax/Tuberculosis (TB)/pneumonia/Lung cancer, etc.,Suggest to respiratory or thoracic surgery clinic.Hiatal hernia can be characterized by retrosternal pain,Its characteristic is lying position when symptoms worse,Recommend watching thoracic surgery.Mediastinal tumor is oppressive nerve/thoracic/The ribs,Produced with persistent pain and difficulty breathing/Have a cough/Hearing, etc.,Suggest watching oncology and thoracic surgery.

　　看皮肤科 仅仅是胸部表面皮肤痛，而且是针刺样、烧灼感甚至电击感，伴随典型皮肤疱疹出现，即半侧胸部出现皮肤发红，进而有疱疹形成，应考虑为带状疱疹或带状疱疹后遗神经痛，应该去皮肤科或神经内科就诊。

看皮肤科 仅仅是胸部表面皮肤痛,And it's like/A burning sensation and even electric shock,Along with the typical skin sores,The side chest redness of the skin,Which have herpes,Consideration should be given for herpes zoster or after herpes zoster neuralgia,Should go to a dermatologist or nerve internal medicine doctor.

　　看神经内科 胸痛伴有经常性落枕、脖子疼、肩膀疼等症状，则应怀疑是颈椎问题，建议去神经内科就诊。胸椎或胸段脊髓本身的炎症、肿瘤、外伤或先天性异常等压迫胸段脊髓或神经根导致的胸部肋间神经痛、胸痛，建议看神经内科。

看神经内科 Chest pain伴有经常性落枕/Pain in the neck/Shoulder pain and other symptoms,Should be suspected to be a cervical vertebra problems,Suggest to neurology clinic.Inflammation of the lining of the thoracic or segmental spinal cord itself/The tumor/Trauma or congenital anomalies such as oppression of segmental spinal cord or nerve root cause chest intercostals neuralgia/Chest pain,Suggest the neurology.

　　看消化内科 胸痛伴有吐酸水、嗳气、胸骨后灼烧感，与进食有明显关系，多为食管、胃肠道疾病，如伴有吞咽困难，多考虑为食管病变。伴随血便、黑便、眩晕者，应考虑活动性消化性溃疡。急性胰腺炎、胆石症、胆囊炎也可引起胸痛。

看消化内科 Chest pain伴有吐酸水/belching/Retrosternal burning sensation,Have obvious relationship with food,More for esophageal/Gastrointestinal diseases,As with difficulty swallowing,More consideration for esophageal lesions.Along with the blood/black/Vertigo is a,Consideration should be given active peptic ulcer.Acute pancreatitis/Cholelith disease/胆囊炎也可引sinceChest pain.

　　看骨科或风湿科 在触摸时、打喷嚏后、牵拉后出现疼痛，或胸痛伴有局部肋骨明显压痛，常属于肌肉骨骼和神经性疼痛，如软组织损伤、肩周炎或肋软骨炎，建议去看骨科。如果卧位后疼痛迅速缓解或向前弯腰时疼痛触发，则有可能是椎间盘病变，建议去骨科或疼痛科就诊。强直性脊柱炎导致的胸痛建议看风湿免疫科。

看骨科或风湿科 在触摸时/After sneezing/Force after the pain,Or chest pain associated with local ribs obvious tenderness,Always belongs to the musculoskeletal and neuropathic pain,Such as soft tissue injuries/Periarthritis of shoulder or rib cartilage inflammation,Suggest to go to the bone.If lying position after rapid pain relief or slouch when trigger pain,May be is disc lesions,Suggest to orthopedic or pain clinic.Chest pain caused by ankylosing spondylitis suggest see. Li rheumatism lead of the.

　　看感染科 流行性肌痛时可出现胸、腹部肌肉剧烈疼痛，可向肩部、颈部放射。疼痛性质多样，可为压迫性痛、刺痛、刀割样或撕裂样的疼痛，同时可伴有发热、咽痛和头痛等感染症状。此症多由柯萨奇及埃可病毒1、6、9型引起，建议去看感染科。

看感染科 流行性肌痛时可出现胸/Abdominal muscle pain,To the shoulder/The neck radiotherapy.Pain in the nature of diversity,Can be oppressive/sting/Sample knife to cut or tear the pain,At the same time may be accompanied by fever/Infection symptoms such as sore throat and headache.Pd by coxsackie and el virus 1 more/6/9型引since,Suggest to go to the infection.

　　看心理门诊 有一些胸痛伴胸闷，与情绪变化有关，持续时间长且位置不固定，并在体力活动后缓解，多为植物神经功能紊乱引起，应先去心血管内科就诊排除心血管疾病，必要时去心理咨询门诊。伴有压力相关症状如头痛、呼吸困难、过度换气或恐慌、濒死感，需考虑精神科相关疾病。

看心理门诊 有一些Chest pain伴胸闷,Related to mood changes,Long duration and location is not fixed,And ease after physical activity,多为植物神经功能紊乱引since,Cardiovascular internal medicine clinic should be to remove the cardiovascular disease,When it is necessary to go psychological counseling outpatient service.Stress-related symptoms such as headache/Difficulty in breathing/Hyperventilation or panic/dying,Should be considered related to psychiatric illness.

　　偶尔轻微胸痛可暂时观察

偶尔轻微Chest pain可暂时观察

　　引起胸痛的疾病广泛且复杂，外伤、炎症、肿瘤及某些理化因素所致的组织损伤，刺激肋间神经、膈神经、脊神经后根和迷走神经等，刺激分布在食管、支气管、肺脏、胸膜、心脏及主动脉的神经末梢，均可引起胸痛。

引sinceChest pain的疾病广泛且复杂,trauma/inflammation/Tissue damage caused by tumor and some physical and chemical factors,Stimulate the intercostals nerve/Phrenic nerve/After the spinal nerve root and the vagus nerve, etc,Stimulate the distribution in the esophagus/bronchial/The lungs/The pleura/The heart and aorta nerve endings,均可引sinceChest pain.

　　有些胸痛是非致命性的，耽误几天没有生命危险。然而有些会导致生命危险，即高危的胸痛一刻也不能耽误，如急性心肌梗死、主动脉夹层、急性肺栓塞、张力性血气胸等，应给予足够的重视，尽早就诊，以免延误病情。总的来说，偶尔的轻微胸痛可以先观察一段时间，持续严重的疼痛一定要及时去看医生。

有些Chest pain是非致命性的,Delay a few days not life threatening.However, some can lead to life-threatening,Is at high risk of chest pain can't delay,Such as acute myocardial infarction/Aortic dissection/Acute pulmonary embolism/Delayed hemopneumothorax tension, etc,Should be given enough attention,See a doctor as soon as possible,So as not to delay treatment.On the whole,The occasional mild chest pain to observe for a period of time,Continuous severe pain must go to see a doctor in time.