Advertisement

Acute Chest Pain in the Young Adult

      Abstract

      The complaint of chest pain in an individual may be caused by a myriad of causes, including cardiac, pulmonary, gastrointestinal, and musculoskeletal causes. In the younger adult, it is uncommon for a serious cause of cardiac or pulmonary disease to be the etiology. This article presents 2 cases of adults under the age of 23 who presented to family practice clinicians and reviews 3 potentially life-threatening diagnoses (cardiomyopathy, pericarditis, and pericardial effusion). Patient presentation, diagnostic features, and treatment options are discussed for each of these diagnoses. New, emerging treatment options are also reviewed.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Amsterdam E.A.
        • Kirk J.D.
        • Bluemke D.A.
        • et al.
        Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association.
        Circulation. 2010; 122: 1756-1776
        • Haasenritter J.
        • Aerts M.
        • Bösner S.
        • et al.
        Coronary heart disease in primary care: accuracy of medical history and physical findings in patients with chest pain—a study protocol for a systematic review with individual patient data.
        BMC Fam Pract. 2012; 13: 81
        • Bösner S.
        • Haasenritter J.
        • Becker A.
        • et al.
        Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule.
        CMAJ. 2010; 182: 1295-1300
        • Collin M.J.
        • Weisenthal B.
        • Walsh K.M.
        • et al.
        Young patients with chest pain: 1-year outcomes.
        Am J Emerg Med. 2011; 29: 265-270
        • Richardson P.
        • McKenna W.
        • Bristow M.
        • et al.
        Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies.
        Circulation. 1996; 93: 841-842
        • Luk A.
        • Ahn E.
        • Soor S.G.
        • Butany J.
        Dilated cardiomyopathy: a review.
        J Clin Pathol. 2009; 62: 219-225
        • Ferri F.
        Ferri's Clinical Advisor 2014. 1st ed. Mosby, Inc., Philadelphia, PA2013
        • Wexler R.K.
        Cardiomyopathy: an overview.
        Am Fam Physician. 2009; 79: 778-784
        • Sivagnanam K.
        • Chaudari D.
        • Lopez P.
        • Sutherland M.E.
        • Ramu V.K.
        “Bath salts” induced severe reversible cardiomyopathy.
        Am J Case Rep. 2013; 14: 288-291
        • Jordan J.T.
        • Harrison B.E.
        Bath salt ingestion: diagnosis and treatment of substance-induced disorders.
        J Nurse Pract. 2013; 9: 403-410
      1. Schiller NB, Ren X, Ristow B. Echocardiographic recognition of cardiomyopathies. UpToDate. http://www.uptodate.com/contents/echocardiographic-recognition-of-cardiomyopathies. Accessed August 13, 2013.

        • American College of Cardiology Fellows/American Heart Association
        2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults.
        Circulation. 2009; 119: e391-e479
        • Heart Failure Society of America
        Executive Summary: HFSA 2010 Comprehensive Heart Failure Practice Guideline.
        J Card Fail. 2010; 16: 475-539
        • Shammas N.W.
        • Padaria R.F.
        • Coyne E.P.
        Pericarditis, myocarditis, and other cardiomyopathies.
        Prim Care. 2013; 40: 213-236
        • Sheth S.
        • Wang D.D.
        • Kasapis C.
        Current and emerging strategies for the treatment of acute pericarditis: a systematic review.
        J Inflamm Res. 2010; 3: 135-142
      2. Imazio M. Clinical presentation and diagnostic evaluation of acute pericarditis. UpToDate. http://www.uptodate.com/contents/clinical-presentation-and-diagnostic-evaluation-of-acute-pericarditis. Accessed August 12, 2013.

        • Tingle L.E.
        • Molina D.
        • Calvert C.W.
        Acute pericarditis.
        Am Fam Physician. 2007; 76: 1509-1514
        • Knowlton K.U.
        • Savoia M.C.
        • Oxman M.N.
        Myocarditis and pericarditis.
        in: Mandell G.L. Bennett J.E. Dolin R. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingston Elsevier, Phildadelphia, PA2010: 1153-1172
        • Khandaker M.H.
        • Espinosa R.E.
        • Nishimura R.A.
        • et al.
        Pericardial disease: diagnosis and management.
        Mayo Clin Proc. 2010; 85: 572-593
        • Mattu A.
        • Martinez J.P.
        Pericarditis, pericardial tamponade, and myocarditis.
        in: Adams J.G. Emergency Medicine: Clinical Essentials. 2nd ed. Elsevier, Philadelphia, Pennsylvania2013: 514-520
        • Sharieff G.Q.
        • Tylie T.
        Pericarditis, myocarditis, and endocarditis.
        in: Baren J.M. Rothrock S.G. Brennan J.A. Brown L. Pediatric Emergency Medicine. Elsevier, Philadelphia, PA2008: 500-503
        • Lotrionte M.
        • Biondi-Zoccai G.
        • Imazio M.
        • et al.
        International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences.
        Am Heart J. 2010; 160: 662-670
        • Lewinter M.M.
        • Tischer M.D.
        Pericardial diseases.
        in: Bonow R.O. Mann D.L. Zipes D.P. Libby P. Braunwald's Heart Disease—A Textbook of Cardiovascular Medicine. 9th ed. Saunders, Philadelphia, Pennsylvania2012: 1651-1671
      3. Hoit B. Diagnosis and treatment of pericardial effusion. UpToDate. http://www.uptodate.com. Accessed August 13, 2013.

        • Gumrukcuoglu H.A.
        • Odabasi D.
        • Akdag S.
        • Ekim H.
        Management of cardiac tamponade: a comperative study between echo-guided pericardiocentesis and surgery—a report of 100 patients.
        Cardiol Res Pract. 2011; 2011: 197838
      4. Mankad S, Sinak LJ. Technique of pericardiocentesis. UpToDate. http://www.uptodate.com. Accessed August 13, 2013.

      Biography

      Barbara Ann Mullen, FNP-BC, is a Commander in the Nurse Corps, US Navy at Branch Health Clinic, Washington Navy Yard in Washington, DC.