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Thoraxschmerz

Chest pain

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Beim Thoraxschmerz unterscheidet man pleuritische, mediastinale und Thoraxwandschmerzen, um eine differenzialdiagnostische Abklärung zu erleichtern. Der Patient mit akutem Thoraxschmerz stellt nach wie vor eine große diagnostische Herausforderung dar. Typische Angina pectoris, das akute Koronarsyndrom bzw. der akute Myokardinfarkt hat eine hohe Prävalenz bei Patienten in der Notambulanz. Darüber hinaus sind auch extrakardiale Ätiologien des Thoraxschmerzes potenziell lebensbedrohlich und erfordern eine korrekte Interpretation der Klinik und rasches adäquates Management: akute Aortendissektion, akute Lungenarterienembolie, Spannungspneumothorax, spontane Ösophagusruptur (Boerhaave-Syndrom). Chronische Thoraxschmerzen können durch ein weites Spektrum an Differenzialdiagnosen verursacht werden. Die Abklärung sollte eine detaillierte Anamnese und körperliche Untersuchung mit einschließen, die häufig richtungweisend sind.

Abstract

The differentiation of chest pain into three categories (pleuritic, mediastinal/central, chest wall pain) improves the efficient diagnostic work-up. The patient presenting with chest pain is still a great diagnostic challenge for the clinician. Typical angina pectoris due to an acute coronary syndrome or myocardial infarction are the most prevalent diagnoses in the emergency department. However, acute chest pain often does not have a cardiac etiology. Thus, other life-threatening conditions such as acute aortic dissection, acute pulmonary embolism, tension pneumothorax, and spontaneous rupture of the esophagus (Boerhaave’s syndrome) must be sought. The correct interpretation of symptoms, efficient diagnostic work-up, and immediate adequate management of these emergency conditions are crucial. The differential diagnosis of chronic chest pain is complex. The assessment should include a detailed medical history and physical examination.

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Authors and Affiliations

  1. Abteilung Innere Medizin III, Medizinische Klinik, Universität Heidelberg

    K. Kurz, E. Giannitsis &  F. J. Meyer

  2. Abteilung Innere Medizin III, Medizinische Klinik, Universität Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg

    F. J. Meyer

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  1. K. Kurz
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  2. E. Giannitsis
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  3. F. J. Meyer
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Correspondence to F. J. Meyer.

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Kurz, K., Giannitsis, E. & Meyer, F.J. Thoraxschmerz. Pneumologe 2, 188–198 (2005). https://doi.org/10.1007/s10405-005-0038-z

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  • DOI: https://doi.org/10.1007/s10405-005-0038-z

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