Cardiac pain

Afferent input from cutaneous and visceral nociceptors is known to converge on spinal neurons, which accounts for the referral of pain between visceral and cutaneous structures (e.g. cardiac pain gets referred to the chest and left upper arm in patients suffering from angina pectoris). Projection neurons in the spinal dorsal horn project to cell nuclei in supraspinal areas such as the thalamus, brainstem and midbrain. Of these, the synaptic junctions in the thalamus play a very important role in the integration and modulation of spinal nociceptive and non-nociceptive inputs. Nociceptive inputs are finally conducted to the cortex where the sensation of pain is perceived (Fig. 1). The mechanisms via which the cortex processes nociceptive inputs are only poorly understood. 

Calcium Channel Blockers. The calcium channel blockers work by blocking the influx of calcium, an excitatory ion, into the cell. The first calcium channel blocker, verapamil (Calan), was introduced in the 1960s. Others, including diltiazem, nifedipine, and nimodipine, are now available. The calcium channel blockers have been used to treat a variety of medical conditions including high blood pressure, cardiac pain (angina) and arrhythmias, migraines, seizure disorders, and premature labor. 

These analgesics are chiefly used for the relief of postoperative pain, cardiac pain and pains of terminal cancer, and in child birth. 

Gold H, KwitNT, Otto H. The xanthines (theobromine and aminophyUine) in the treatment of cardiac pain. JAMA 1937 108 2173-9. 

Gyceryl trinitrate is a vasodilator drug used for the relief of cardiac pain on exertion - angina pectoris. 

Severe cardiac pain, chest tightness, sweating, breathlessness and nausea. Some patients may present with atypical features including indigestion, pleuritic chest pain or dyspnoea. 

CANNABIS DRUGS OF ABUSE -COCAINE Quickens the onset of effects of cocaine and t bioavailability of cocaine, leading to enhanced subjective effects of cocaine (e.g. euphoria), and t heart rate and other cardiac effects such as ischaemia Attributed to cannabis-induced vasodilatation of the nasal mucosa, which leads to t absorption of cocaine Be aware. May be the cause of ischaemic cardiac pain in young adults... 

The most common cardiac effects are atrioventricular block, sinus bradycardia, and ventricular extra beats. Occasionally serious dysrhythmias occur (SEDA-17, 219), including ventricular fibrillation (15). ATP can cause transient atrial fibrillation (16). Chest pain occurs in 30-50% of patients and dyspnea and chest discomfort in 35-55%. Chest pain can occur in patients with and without coronary artery disease, and the symptoms are not always tjrpical of cardiac pain. 

Angina pectoris is acute cardiac pain caused by inadequate blood flow (decreased oxygen) resulting from occlusion of coronary arteries or coronary artery spasm. Antianginals treat angina pectoris (Table 19.1) by ... 

Viagra is a trade name marketed by Pfizer Pharmaceutical Company and is chemically sidenafil citrate. Researchers did not start CTeating a drug for impotence. The chemical compound was developed originally for angina (severe but tanporary attack of cardiac pain) and is chemically an inhibitor for an enzyme phosphodiesterase (see the previous section, for example, for the idea of enzyme inhibitor). The drug was not successful in treating heart problems, but many of the test subjects reported their successes in bedroom activity. It turned out that the compound inhibits... 

Palpation along the sternal border anteriorly will reveal ribs that have moved anteriorly (anterior ribs), a common cause of anterior chest wall pain. The patient may mistake rib dysfunction on the left side for cardiac pain. Tenderness and tissue changes may be palpated along the sternal border and at the costochondral junction in the case of somatic dysfunction. 

Costochondritis is an inflammation of the costochondral junction. It is sometimes known as anterior chest wall syndrome. It is characterized by chest pain aggravated by coughing, sneezing, or deep inhalation. The patient often believes he is having cardiac pain, so this can be a frightening condition. Adding to the diagnostic problem is the fact that the pain can radiate to the shoulder. 

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