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Sometimes associated symptoms of a sour taste in the mouth and mild nausea are associated with esophagitis. An esophageal tear or spasm causes more acute, severe chest pain, described as a “tearing” or “crushing” sensation. Frequently, the patient experiencing pain of GI origin reports mild to moderate chest pain occurring intermittently over days to months. Peptic ulcer and cholecystitis can cause chest pain. Hematemesis (blood in the emesis) or hematochezia (blood in the stool) frequently accompanies peptic ulceration. Cholecystitis is frequently reported as right anterior chest pain that radiates to the shoulder or upper back. Acute pancreatitis should be considered if the chest pain is severe and constant and is reported in the epigastric area of the abdomen, radiating to the chest, shoulder, and arm. Pancreatitis is often accompanied by hypotension. Physical examination and diagnostic tests are necessary to differentiate it from chest pain of cardiovascular origin. Could this pain be from a systemic cause? Key Questions • Do you have any skin problems? • Do you have any chronic health problems? 6/25/2019
Skin symptomsIf the patient reports persistent unilateral chest pain of pruritic, burning, or stabbing quality, consider herpes zoster. This pain will follow the distribution of a cervical or thoracic nerve root. A vesicular rash in the area of pain is characteristic; this rash occurs several days after the occurrence of chest pain. Systemic conditions Chest muscle pain can be caused by localized inflammation of the muscles in collagen diseases, such as polymyositis, fibromyalgia, or systemic lupus erythematosus. Arthritic inflammatory changes of the cervical and thoracic spine and shoulders can produce upper chest pain. This pain is aggravated by range of motion of the affected joints. Sickle cell disease (SCD) can cause chest pain. In sickle cell anemia, the erythrocytes become rigid and “sickle,” leading to capillary occlusion and sickle cell crisis. The heart increases the stroke volume to compensate for the anemia. The heart gradually dilates and heart failure ensues. Chest pain in a patient with SCD can also originate from acute coronary syndrome. In this condition, chest pain, fever, dyspnea, and cough are caused by infarction of lung tissue or an infectious agent. Marfan syndrome is a hereditary connective tissue disease. Cardiovascular involvement occurs in more than 50% of people by age 21 years. Mitral valve involvement is common, with auscultatory findings of mitral regurgitation and MVP. Marfan syndrome is associated with an increased risk of aortic dissection. Kawasaki disease often has a longterm complication of CAD, coronary occlusion, or MI.