Diagnosis and prognosis of chest pain in elderly patients

doi:10.3877/cma.j.issn.1674-0785.2018.10.004

Abstract

Abstract:

Chest pain is one of the most common symptoms in the elderly. In China, the rate of misdiagnosis and missed diagnosis of chest pain in elderly patients is relatively high. In this paper, we discuss the epidemiology, mechanism, etiology and classification, clinical manifestations and risk assessment, treatment, and prognosis of chest pain in elderly patients, with an aim to standardize the evaluation and diagnosis of chest pain in elderly patients, improve its diagnosis and treatment, and facilitate rational use of medical resources.

Key words: Chest pain, Elderly, Diagnosis, Treatment, Prognosis

Lun Zhou, Cuntai Zhang. Diagnosis and prognosis of chest pain in elderly patients[J]. Chinese Journal of Clinicians(Electronic Edition), 2018, 12(10): 552-558.

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References 16

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分类			常见病因
致命性胸痛			?
?	心源性		急性冠状动脉综合征、主动脉夹层、心脏挤压伤
?	非心源性		急性肺栓塞、张力性气胸
非致命性胸痛			?
?	心源性		稳定型心绞痛、急性心包炎、心肌炎、肥厚型梗阻性心肌病、主动脉瓣疾病、左房室瓣脱垂等
?	非心源性		?
?	?	呼吸系统	肺动脉高压、肺炎、肺癌、急性气管-支气管炎、自发性气胸、胸膜炎、胸膜肿瘤等
?	?	消化系统	反流性食管炎、食管癌、食管烫伤或化学性损伤、急性胰腺炎、胆囊炎、消化性溃疡和穿孔等
?	?	纵隔	纵隔肿瘤等
?	?	胸壁	肋软骨炎、带状疱疹、肋间神经炎、皮下蜂窝织炎、肋骨骨折、急性白血病及多发性骨髓瘤等所致骨痛
?	?	心理性	抑郁症、焦虑症等
?	?	其他	过度通气综合征、颈椎病等

分类			常见病因
致命性胸痛			?
?	心源性		急性冠状动脉综合征、主动脉夹层、心脏挤压伤
?	非心源性		急性肺栓塞、张力性气胸
非致命性胸痛			?
?	心源性		稳定型心绞痛、急性心包炎、心肌炎、肥厚型梗阻性心肌病、主动脉瓣疾病、左房室瓣脱垂等
?	非心源性		?
?	?	呼吸系统	肺动脉高压、肺炎、肺癌、急性气管-支气管炎、自发性气胸、胸膜炎、胸膜肿瘤等
?	?	消化系统	反流性食管炎、食管癌、食管烫伤或化学性损伤、急性胰腺炎、胆囊炎、消化性溃疡和穿孔等
?	?	纵隔	纵隔肿瘤等
?	?	胸壁	肋软骨炎、带状疱疹、肋间神经炎、皮下蜂窝织炎、肋骨骨折、急性白血病及多发性骨髓瘤等所致骨痛
?	?	心理性	抑郁症、焦虑症等
?	?	其他	过度通气综合征、颈椎病等

诊断	临床表现	体检	相关检查
急性冠状动脉综合征	性质不定，压榨感，放射痛伴大汗，呼吸困难，恶心	大汗，肺部啰音	心电图，心肌标志物
肺栓塞	突然起病，胸膜痛，呼吸困难	呼吸困难，心动过速，深静脉血栓	血气、胸片，D-二聚体
主动脉夹层	撕裂样痛，放散至后背或腹部，严重时神经精神症状	新出现杂音，肢体血压不一致，无脉症	胸片、CT、造影、心脏超声、磁共振
气胸	胸膜痛，呼吸困难，干咳	呼吸音降低	胸片

诊断	临床表现	体检	相关检查
急性冠状动脉综合征	性质不定，压榨感，放射痛伴大汗，呼吸困难，恶心	大汗，肺部啰音	心电图，心肌标志物
肺栓塞	突然起病，胸膜痛，呼吸困难	呼吸困难，心动过速，深静脉血栓	血气、胸片，D-二聚体
主动脉夹层	撕裂样痛，放散至后背或腹部，严重时神经精神症状	新出现杂音，肢体血压不一致，无脉症	胸片、CT、造影、心脏超声、磁共振
气胸	胸膜痛，呼吸困难，干咳	呼吸音降低	胸片

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