CHEST WALL PAIN

Cervical Disk:
A cervical disk may irritate the nerve roots going to the chest wall and produce chronic chest pain that is aggravated by walking and certain body positions. The pain tends to be more superficial than that seen with obstructive coronary artery disease and is more likely to be present at rest.

Thoracic Outlet Syndrome:
The nerves and blood vessels that enter the arm often have to go through a bottleneck of muscles. If a blood vessel or a nerve is kinked by a muscle or a rib, arm and chest pain may develop that is associated with walking. Since exertional chest pain is a hallmark of coronary artery disease, it is easy to see why confusion may arise. The pain is induced by swinging of the arms, and can be reproduced by elevating the arm and rotating it.

Tietze's Syndrome:
Inflammation and swelling of the cartilage between the rib and breastbone (costochondral or chondrosternal joints is known as Tietze's syndrome. Such chest pain tends to be superficial rather than deep, is aggravated by breathing, and is very tender if the area is pressed.

Tenderness of the muscles of the chest wall:
A variety of factors may be responsible for tenderness of chest wall muscles including injury from direct trauma (usually several days before the onset of pain), coughing, and weight lifting causing a pulled muscle. Usually the chest pain is localized to a small area, is brief while it lasts, is aggravated by chest wall movements, turning, twisting and deep breathing, and may last many hours.

Herpes Zoster:
A severe skin rash that does not spread beyond the midline, may cause extreme chest pain in the pre-eruptive stage. Typically the skin is extremely sensitive over the involved area. Herpes may not be suspected until the skin eruption actually occurs.

Hyperventilation Syndrome:
An extremely common cause of chest pain is the hyperventilation syndrome. Hyperventilation is simply over breathing as a result of anxiety or fear. It also has been called panic attacks. Typically the subject unconsciously starts to breath more rapidly and deeply when under stress. The over breathing is often interspersed with deep sighs. In its acute form it will quickly produce a variety of symptoms including lightheadedness, dizziness, a far away feeling, numbness, palpitations, blurred visions, flushing, and tingling of the hands and around the mouth. Sometimes the victim will even faint. In its milder form, the subject may be constantly over breathing throughout the day. In so doing there is increased use of the chest muscles. If there is enough overuse of these muscles, they will become painful producing chest pain. Usually the victim is not consciously aware that he is over breathing, but rather feels short of breath. When this is associated with pounding of one's heart, dizziness, blurred vision and the other symptoms of hyperventilation, it is not hard to understand the panic that may accompany this disorder. Because the symptoms are due to over breathing and blowing off of carbon dioxide from the lungs, the chest pain and shortness of breath do not occur during exertion but rather at rest. Indeed, physical exertion, which will produce carbon dioxide, makes the victim feel better.

Primary Muscle Pain:
This includes some poorly understood disorders that have been called fibrositis, fibromyalgia, myalgia and neuralgia. The pain of these disorders tend to be chronic and ill-defined by the patient, are usually not related to exertion, and are confined to localized areas of the chest in locations that are different than what is seen with cardiac pain. The patient is usually more concerned about the significance of the symptoms, and whether it is a sign of heart disease rather than the intensity of the pain.

Cancer
may originate or spread to any structure in the chest including the heart and cause chest pain. Such pain tends to be continuous and not related to physical exertion. The diagnosis often may be made by a chest x-ray. Cancer also may spread to the spine and vertebrae with irritation of the nerve roots that go to the chest. Such pain may be quite severe and will not respond to the usual cardiac medications.

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CHEST PAIN FROM OTHER AREAS WITHIN THE CHEST

Lungs:
A variety of disorders involving the lung may be associated with chest pain. Pneumonia is one of the most common, particularly when it involves the lining of the surface of the lung known as the pleura. Inflammation of the pleura is called pleurisy. Pleuritic pain tend to be sharp, and of brief duration when it is present. Typically it may come and go over a period of hours, and tends to occur only during inspiration. When associated with pneumonia, it is usually accompanied by a cough and fever. It also may be a symptom of a pulmonary embolism (see below), the site of metastasis of a malignant tumor, or a sign of one of the autoimmune diseases such as lupus erythematosus. Although pleurisy tends to be localized to a relatively small area of the chest, at times, with the more infectious type, the chest pain may be generalized and cause shortness of breath.

Pulmonary Embolism:
Another major cause of chest pain is a pulmonary embolism. An embolism is a mobile blood clot that usually occurs after a surgical procedure, particularly if the patient has been lying immobile in bed for several days. Immobility and the stress of surgery are associated with stasis of blood in the lower extremities and pelvis. This encourages the formation of blood clots in these areas. An injury to the lower extremities also may result in the formation of a clot, days or even weeks later. Whatever the origin, portions of the clot may break off and migrate to the lungs. This is most likely to occur when attempts are made to ambulate a patient in the post-operative period. Usually such a clot lodges in the small blood vessels in the lung. If the clot is a large one, it may be associated with coughing up of blood, shortness of breath, pain intensified by deep breathing, and even sudden death. The pain associated with a pulmonary embolism may be indistinguishable from both cardiac ischemia and the pain of an acute heart attack. Chest pain may be the first clue that a clot is present in the legs or thighs. In general, prolonged bed rest for any reason encourages the formation of blood clots in the lower half of the body followed by a pulmonary embolus. Usually the diagnosis of an embolism can be made by chest x-ray, however, special tests and procedures may be required in more obscure cases.

Pneumothorax:
A pneumothorax is an important cause of chest pain. It occurs when air perforates the outer surface of the lung forcing ambient air into the chest cavity. When this happens, the victim suffers chest pain followed by collapse of the perforated lung and shortness of breath. Usually the pain is in the lateral chest rather than the center of the chest, and it may be aggravated by breathing. The diagnosis of pneumothorax can readily be made with a chest x-ray. It also may be identified on physical examination, if the doctor takes the trouble to listen to both lungs.

Mediastinal emphysema
refers to the presence of air in the central portion of the chest cavity that contains the heart. Because the air may create pressure and stretching of the structures and nerves within the mediastinum, severe chest pain may result. In addition, because the stretched nerves involve the same nerve roots as the nerves coming from the heart, it may be very similar to cardiac pain. Usually the pain is more superficial and tends to be modified by respiration and body position. This disorder can be diagnosed by a chest x-ray.

Pulmonary Hypertension
is a rare cause of chest pain. As you might infer, this is an elevation of the pressure in the pulmonary arteries. The pulmonary artery is the artery that exits from the right ventricle. Before it enters the lungs and branches into tiny blood vessels, it contains unoxygenated, venous blood. A number of diseases may cause the pressure in the pulmonary artery to become elevated including various forms of congenital heart disease, mitral stenosis (obstruction of the mitral valve), chronic lung disease, and primary pulmonary hypertension. Although primary pulmonary hypertension is an extremely rare disease, it has recently been found to be a side effect of certain medications used for weight loss. The chest pain associated with pulmonary hypertension occurs with exertion and is relieved by rest, and may be indistinguishable from the chest pain associated with cardiac ischemia. Indeed, it is thought that the pain seen in this condition is due to ischemia of the right ventricle. Except for chronic lung disease, the various conditions giving rise to pulmonary hypertension occur in a much younger group of people, and the chest pain that develops does not respond to the usual cardiac medications. The diagnosis of all these disorders can be made from a careful physical examination, chest x-ray, and even the electrocardiogram.

Aortic Valve Disease:
The aortic valve is the exit valve of the heart and all blood must leave the heart through this opening. Immediately after the aorta exits from the heart, the coronary arteries arise and supply the heart muscle with blood. If the aortic valve is diseased and obstructed, the blood flow exiting from the heart eventually will be reduced, even though the pressure within the left ventricular chamber becomes markedly elevated. At the same time, the pressure within the aorta beyond the valve will be reduced, and the amount it is reduced depends upon how obstructed the aortic valve becomes. If pre-existing coronary artery disease is present, a previously insignificant degree of narrowing in a coronary artery may now become very significant. The result will be a reduction in blood flow and chest pain. Usually, if significant aortic stenosis is present, the murmur associated with it is readily heard. Unfortunately, the modern cardiologist has become so technology oriented that frequently he does not even bother to listen to a patient's heart with a low technology instrument such as the stethoscope. Even if he does so conscientiously, the blood flow through the valve may be so reduced that no murmur can be heard.

Mitral Valve Prolapse
has been claimed to cause chest pain. There is no anatomical reason why mitral valve prolapse should cause chest pain. Because both this disorder and recurring chest patient pain are so common, mitral valve prolapse is often discovered coincidentally in the evaluation of a patient with chest pain symptoms. Also, mitral valve prolapse may accompany obstructive coronary artery disease; however it is the coronary artery disease that produces the chest pain and not the mitral valve prolapse.

Pericarditis:
This is due to an inflammation of the membrane surrounding the heart called the pericardium, and is accompanied by unique changes in the electrocardiogram. Viral and bacterial infections may sometimes involve the pericardium and will produce chest pain very similar to that seen with cardiac pain. The pain of pericarditis, however, is aggravated by deep breathing and influenced by changes in body position. It may cease when the breath is held or if the victim leans forward. Pericarditis is not a common disorder. Because of its similarity to cardiac pain, and the unique changes seen on the electrocardiogram, it easily can be mistaken for an impending heart attack. If coincidental coronary artery disease is found on an angiogram, and if the doctor seeing the patient is an aggressive cardiologist, potentially dangerous coronary artery bypass surgery may be performed that not only is unnecessary, but possibly harmful to the patient.

Dissecting aneurysm of the aorta
is enlargement and separation of the wall of the aorta, the main artery exiting from the heart. When present, it may cause chest pain and be mistaken for an acute heart attack. When chest pain is present, it usually is severe, may involve the back and even the abdomen, and is a medical emergency. If the artery ruptures through the weakened portion of the aortic wall, death is immediate. Milder forms of dissection may be confused with a heart attack but can usually be diagnosed by a simple chest x-ray. However, if an x-ray is not taken, and the patient is made to undergo angiograms, there will be prolonged delay during which the aneurysm may rupture.

Syphilis:
While syphilis is rarely seen today, it occasionally does occur, particularly in individuals who spent their earlier years in undeveloped countries where this disease is still prevalent. The lesions of syphilis have a predilection for the ostia of the coronary arteries; that is, where the coronary arteries exit from the aorta just above the aortic valves. By causing marked narrowing of the ostia, blood flow is markedly reduced in the coronary arteries. This will cause chest pain that is identical to that caused by obstructive coronary artery disease. Surgical intervention as well as antibiotic treatment of the syphilis are the recommended forms of therapy.

Premature Beats
may be accompanied by a sharp, stabbing pain over the heart area, and occasionally may be associated with a fleeting choking sensation. Usually such symptoms occur at rest and decrease during physical activity, but may reoccur when activity ceases.

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The Rapid Spread of Disease

Section Head of Health Office of Disease Eradication Tasikmalaya regency Joseph Romli similar opinion. He suspected that climate change is one factor that can not be removed from the emergence of chikungunya disease in southern Tasikmalaya last few months. In the last two months no fewer than 350 people in District Cikalong, Karangnunggal, Cikatomas, and Pancatengah affected by chikungunya.

The emergence of chikungunya in Tasikmalaya almost simultaneously with the Ciamis. In fact, there are about 1,000 cases of chikungunya in Ciamis findings in the same period.

Lukman added, an unhealthy environment can also lead to more rapid spread of disease. Rice fields and ponds in the neighborhood where the discovery of 13 people who tested positive for microfilariae in Kampung Cimertug, Bantarkalong Village, District Cipatujah, mid last year, turned out to be a nest of mosquitoes. If the patient does not promptly treated, the disease will further spread.

Preventive efforts

Many people know about infectious diseases and to understand the importance of healthy behavior. However, this is often not followed up with real practice in daily life.

Therefore, said the head of Research and Development Loka P2B2 Ciamis Lewis, it's time all parties notice of preventive and promotive in the eradication of infectious diseases. "The handling of the disease in the downstream would not be completed and tend to spend a lot of cost. Therefore, the upstream side must also be worked out," he said.

In addition to the eradication of mosquito breeding that has been commonly known by the community, according to Joseph, there's one more thing that is part of efforts to prevent disease and can be done in the southern region which is still widespread vegetation cover, which does not damage the forest. Forests that are left will be sort of a place of natural insulation spreader animal diseases.

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spread of disease due to weather anomalies

Diphtheria disease is an infectious disease caused by the bacterium Corynebacterium Diphteriae. The disease is easily spread and attack the upper respiratory tract with symptoms of high fever, swelling of the tonsils (tonsils) and led to gross membrane h deputy that grew larger and potentially close the airways.

Besides inhibiting the respiratory tract, diphtheria toxin can also damage the heart muscle resulting in heart failure. Transmission of the disease is generally by air, by coughing or sneezing and through contaminated objects or food bacteria.

Post-forth and back widths

Pawik revealed, in addition to weather anomalies, panyakit diphtheria infection also caused by the mobility of society at the time of Eid. He cited, in the region had not found Situbondo diphtheria. However, after emerging settlers from Madura, the disease grows.

In addition to the displacement of the population, inadequate immunization may also lead to the emergence of diphtheria. According Pawik, during these many mothers who do not fully immunize their children because on average only 80 percent immunization.

Diphtheria disease prevention through immunization is considered the most effective. Immunizations are usually given together with tetanus and pertussis immunization three times since the baby was two months with a hose injection of one to two months. This immunization will provide active immunity against diphtheria, pertussis and tetanus at the same time.

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Disease Prevention Priorities So

Prevention of spread of epidemic diseases into health protection priorities refugee flood victims in the Gulf Wasior Wondama, West Papua.

"Preventive action also remain to be done to avoid a decline in the quality of refugee health. Psychological and physical condition of refugees fairly weak. This requires intensive treatment of all parties, at least until the emergency response phase is completed, "explains Refugee Health Coordinator post in Manokwari, West Papua, Victor Eka Nugraha Putra,

He added that there are four potential disease outbreaks of concern, namely acute respiratory infections (ARI), diarrhea, malaria, and measles. Yesterday, the number of patients are still hospitalized ARD reached 54 people, diarrhea 5 people, while malaria is 5 people.

The rise of ARI, according to Victor, due to the dusty conditions of shelter and heat. Refugees who live in emergency tents often mixed dust inhalation. Similarly, he continued, causing diarrhea.

Problem finding cases of malaria in flood victim, Victor sure, the virus comes from Wasior, instead of evacuation. "To watch the emergence of malaria, pregnant women and babies have got 92 mosquito nets with insecticide," he said.

In addition to curative measures, health teams are also doing some preventive things. Among them, said Victor again, providing motivation for breast-feeding for mothers who carried five health counselors alternately. There are indications, in refugee mothers stop breastfeeding and replace it with formula. "We are concerned, the baby in the evacuation will suffer malnutrition if only to get the intake of milk formula," he said.

In addition, continued Victor, there are also mental assistance, with the help of psychiatrists, psychologists, and nurses soul. The goal, to help refugees overcome the trauma of prolonged pascabanjir flash

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Beware of Malaria in Rainy Season

District Health Office Lebak Banten province, asking local residents wary of the spread of malaria during the rainy season today.

"We are currently wary of the spread of malaria transmission because of high rainfall, and we are also asking residents to be wary of this penyakita deployment," said Chief Health Lebak Maman Sukirman

Malaria is an infectious disease that can cause death, if patients are not given treatment immediately.

During this time, he said, the malaria endemic areas around the southern coast of Lebak, because in these areas if the rainy season becomes a breeding ground for anopheles mosquitoes that live in the lagoon-lagoon coast.

Some districts that have become endemic malaria coast, namely Sub Cihara, Binuangen, Bayah, Cilograng, Malingping, and Panggarangan.

"I ask people who live around the coast guard requested that the disease attacks," he said.

To prevent the spread of malaria illness prompted more people to the movement to eradicate the mosquitoes nest (PSN) and environmental hygiene.

"Movement is more effective to turn off PSN chain of malaria compared with fumigation or fogging," he said.

During this time, Public Health Service has conducted larvaciding spraying to kill mosquito larva of Anopheles breeding in the lagoon-lagoon on the coast.

In addition, also spread the fish's head to lead it to kill mosquito larvae in lagoons around the coast.

Malaria is usually attacked in the high rainfall so that coastal communities were asked to be aware of the disease.

PHC Officers Bayah Lebak Anwar admitted, during these malaria cases are often attacked.

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Climate change is the spread of disease

Skin cancer and respiratory diseases thought to be the first of two diseases caused by the earth's climate changes, which among other things caused by global warming.

"Depletion of the ozone layer in the stratosphere has increased the risk of skin cancer and the increase in temperature due to climate change can increase the concentration of surface ozone, which is one of the major air pollutant and can cause respiratory disease," said Director General of Disease Control and Environmental Health Ministry of Health Tjandra Yoga Aditama in Jakarta, Thursday (20/01/2011).

He explained that climate change will also trigger the reduction of biodiversity so as to cause the scarcity of raw materials from plants.

In addition, land degradation and changes in ecosystem function can cause changes in the spread of disease vectors and declining water resources. This can lead to limited access to clean water and safe sanitation.

Currently in Indonesia, as well as in many countries around the world, started to show signs such as rainfall increased significantly in the wet season and less rainfall in the dry months.

Tjandra explained, climate change affects health through transmission lines and dynamic microbial contamination. Health impact of these processes, among other things, the effect of increased temperature on morbidity and mortality, extreme weather disasters, increased air pollution, water and food borne diseases, and congenital disease vectors and rodents.

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