Dolore toracico
Table of Contents
Definizione
Ildolore toracicoè un sintomo molto frequente, che può manifestarsi come unapugnalata,undolore sordo, come un fastidio o un dolore tra il collo e l’addome superiore. In molti casi la diagnosi è rapida e può salvare la vita.Il 39% della popolazione riferisce di avere avvertito dolore toracico in un certo momento della vita. I pazienti con dolore toracico presentano uno spettro estremamente vasto di segni e sintomi e il medico, in genere, del Pronto Soccorso deve essere in grado di riconoscerlo in tempi ragionevolmente rapidi.
Cause
Le principali cause di dolore toracico possono essere:
- muscoloscheletrico-Fratture costali, stiramenti dei muscoli intercostali
- esofagite da reflusso –Peggiora in condizione supina ma anche durante uno sforzo
- costocondrite-Dolorabiltà alla palpazione. I movimenti del torace influenzano il dolore
- cardiache-Angina stabile/instabile, dissecazione aortica, malattia valvolare, infiammazione delmiocardio e del pericardio
- psichiatriche-Attacchi di panico e sindrome depressiva
- pleurite-Dolore trafittivo con gli atti respiratori
- herpes zoster –Può produrre dolore lancinante con o senza la presenza di una banda alla schiena o intorno alla parete toracica
- pericardite-Dolore influenzato dai cambiamenti di postura e dalla respirazione. Il dolore acuto spesso peggiora durante l’inspirazione.
- dissecazione aortica-Dolore intenso e migrante, improvviso e lancinante. Inizialmente il dolore può essere simile a quello di altre malattie ritardando la diagnosi. La tempestività della diagnosi aumenta notevolmente le probabilità di sopravvivenza.
Cause che possono mettere in pericolo la vita
- sindrome coronarica acuta
- dissecazione aortica
- embolia polmonare
- pneumotorace iperteso
- tamponamento cardiaco
- mediastinite(es. rottura esofagea)
Diagnosi
Una diagnosi precoce è molto importante per almeno due motivi: per la programmazione del trattamento più tempestivo idoneo e per la scelta del reparto di degenza più accurato. E’ importante ottenere una dettagliataanamnesisui fattori di rischio, e comorbidità, gli eventi traumatici recenti, i periodi di immobilizzazione, l’uso di sostanze stupefacenti come cocaina. Inoltre l’anamnesi deve comprendere:
- modalità di insorgenza del dolore, qualità, localizzazione, irradiazione, durata.
Possono essere di aiuto sintomi associate come:
- nausea
- vomito
- sudorazione
- dispnea
- cardiopalmo.
Di estrema importanza sono anche i sintomi che hanno preceduto l’insorgenza del dolore toracico come la febbre o l’edema periferico.
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