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VELOSAN Medical Blog » Urgente medicale If you intresting in nail designs or new styles you must visit our page Nails designs we have many news about nails designs and gallery
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Urgente medicale

Durerea toracica

Dr.Gabriel PERIANU Medic primar-Medicina de urgente

Durerea toracica este unul dintre motivele cele mai importante pentru care pacientii apeleaza la sistemul medical in regim de urgenta.Dar oare toate durerile, toracice, sunt periculoase si necesita evaluare in urgenta? Si daca nu care sunt acestea?

Durerea este cel mai frecvent simptom de boala. Tratamentul acesteia depinde de cauza care o produce si de masura in care sunt inlaturati factorii declansatori si cei agravanti. Astfel, durerea poate fi de origine somatica ( cutanata, articulara, musculara), viscerala (ale organelor interne) sau functionala (fara substrat).

Trebuie stiut ca intensitatea durerii toracice nu este in directa corelatie cu gravitatea cauzei care o produce. Nu intotdeauna o durere acuta, de mare intensitate, semnifica si o boala grava. Dar indiferent de cauza, o durere toracica trebuie evaluata de catre un medic practician.

Diagnosticul diferential al durerii toracice reprezinta intotdeauna o problema pentru medic, care va trebui sa decida de ce natura este durerea si care este gradul urgentei acesteia. Aceasta decizie, deseori dificila, necesita o buna anamneza, tipul durerii, caracterul si intensitatea ei, iradierea si modul de aparitie dar si de disparitie constituind argumente in favoarea unui anume diagnostic, ce va trebui confirmat prin investigatii paraclinice, imagistice si de laborator.

Dintre tipurile de durere, cea somatica, are de obicei un stimul dureros evident, e bine localizata si raspunde la tratamentul cu analgezice antiinflamatoare sau opioide. Durerea viscerala e cel mai adesea declansata de inflamatie, e difuza si de obicei iradiata; se asociaza cu semne nespecifice ( ex.: greata, balonare) si raspunde la analgezice opioide. Durerea functionala nu are stimul nociceptiv evident, are adeseori caracter sfredelitor, de curent electric si se insoteste de semne de leziune nervoasa ( ex: alterari de sensibilitate). Ea raspunde numai partial la analgezicele opioide dar poate raspunde la antiaritmice sau anticonvulsivante. Are un caracter cronic.

In  diagnosticarea unei dureri toracice importanta au tipul si iradierea durerii, contextul de aparitie, conditiile de ameliorare si de agravare, intensitatea, durata si localizarea.

In angina pectorala durerea toracica e resimtita ca o presiune sau constrictie retrosternala, cu iradiere tipica in bratul stang, ce apare de obicei, in conditii de efort dupa mese sau in caz de stres emotional. Specific e faptul  ca ea cedeaza dupa repaos sau la administrarea de nitroglicerina.

In infarctul miocardic acut, durerea e similara cu cea din angina pectorala dar e mult mai intensa, are o durata mai lunga ( mai mare de treizeci de minute) si nu cedeaza imediat la repaus sau la nitroglicerina. Nu rareori pacientii cu infarct miocardic pot prezenta o durere nespecifica, atipica, toracica cu sau fara iradiere in brate, in gat, in mandibula sau interscapulovertebral, insotita de lipsa de aer, greata, transpiratii, ameteli. Aceste simptome, total atipice, pot fi inselatoare chiar si pentru personalul medical avizat, necesitand investigatii paraclinice suplimentare.

O alta cauza de durere toracica este embolia pulmonara unde aceasta poate avea sediu retrosternal sau latero-toracic, fiind accentuata de inspirul profund si insotita uneori de tuse cu sputa sangvinolenta, tahicardie si lipsa de aer.

Durerea toracica poate fi foarte intensa, mediotoracica, “sfasietoare”, iradiata posterior neinfluentata de schimbarile de pozitie ale toracelui, cu puls foarte slab, ca in disectia de aorta.Alte cauze grave de durere toracica pot fi :

-pericardita acuta - cu durere constanta retrosternala, accentuata de tuse si inspirul profund dar ameliorata de pozitia aplecata inainte a trunchiului,

-pleurezia-cu durere unilaterala sub forma de junghi si agravata de tuse si inspir.

Cauze mai putin grave de durere toracica sunt :

-intinderile musculare-dupa efort fizic intens sau prin fracturi costale,

-esofagita de reflux-insotita de tulburari de deglutitie,

-emotiile mari-ce are un caracter sporadic fiind de scurta durata.

Discopatia cervicala, ulcerul gastroduodenal, hernia hiatala, colica biliara, pancreatita, traheobronsita, pneumonia, herpesul zoster dar si nevralgia intercostala pot conduce si ele la acuze de durere toracica.

Dar cum putem deosebi la domiciliu o durere toracica de mare gravitate, o mare urgenta ( precum infarctul miocardic) de una fara importanta? Ghidurile prespitalicesti prevad ca in fata unui pacient cunoscut cu boala cardiaca ischemica si care prezinta durere toracica acuta, se va administra o capsula de nitroglicerina s.l. , apoi se va urmari efectul acesteia. Daca durerea cedeaza in cinci minute se va informa medicul de familie si se va trata pacientul ca pentru angina pectorala.Daca in schimb durerea nu cedeaza in cinci minute de la administrarea unei capsule de nitroglicerina sau durerea se intensifica, se va apela serviciul de urgenta fiind necesar prezenta unui echipaj medical de urgenta. De asemenea se va administra aspirina 162-325 mg/ po in absenta c.i.

In concluzie, putem afirma ca in prezenta unei dureri toracice un pacient va trebui intotdeauna sa apeleze un serviciu medical de urgente.