On any matter relating to your health or well-being, please check with an appropriate health professional. He embraces an active lifestyle combining diet, exercise and healthy choices. Once life-threatening causes have been ruled out (either by patient history, examination, or rapid diagnostics), a more thorough history and examination should be performed to narrow the differential diagnosis and guide further diagnostic workup and therapy. Diuretic Strategies in Patients with Acute Decompensated Heart Failure. 2013 ACCF/AHA Guideline for the Management of HeartFailure. specifications following safe manufacturing practices. Relationship between location of chest pain and site of - PubMed lessons in math, English, science, history, and more. The features that physicians rely on are associated symptoms that often accompany retrosternal chest pain and point to the particular underlying cause. This area, called the mediastinum, is surrounded by your breastbone in front, your spine in back and your lungs on each side. Retrosternal chest pain is commonly described as stinging, agonizing, compressing, and/or crushing in nature. Critical Care Nursing: Scenarios & Case Studies, Therapeutic Communication Techniques & Examples | Communication in Nursing, Reflex Arc Function & Loop | Components of Reflex Arc. . A fractured sternum is very painful because of the nature of the injury, and other internal injuries may also be associated with it. It may extend to the neck, left arm or the back. What is the difference between retrosternal pain and sub sternal pain. Pleurisy treatment is based on the underlying cause of the inflammation. Pleura is the tissue sheet between the ribcage and lungs; inflammation in these sheets is known as pleurisy. Substernal Goiter Article Stress and rest image of the left ventricular myocardium using Tc-99m . Substernal chest pain is quite painful that usually feels below or behind the sternum bone. Additionally, a code is needed to report the reason why the procedure was cancelled. substernal vs midsternal chest pain - ReallyOpen A doctor prescribes medicines to stop clot formation in arteries. When acid from your stomach moves up into your esophagus, it can cause a burning pain in your chest. substernal vs retrosternal chest pain - wolfematt.com By working to inform readers of the options available to them, he hopes to improve their health and quality of life. substernal vs retrosternal chest pain - nestorhugofuentes.com Additional tests for diagnosis include: Substernal chest pain treatment will first rely on correctly identifying the underlying cause. The doctor ordered a chest x-ray for Amanda. If you are not happy, send back all of your bottles within 30 days, of receiving the product and we will issue you a. Retrosternal Hematoma Causes & Treatment - Study.com The diagnostic evaluation of undifferentiated chest pain aims to first rule out immediately life-threatening causes of chest pain and then determine the etiology, guided by the pretest probability of the diagnoses under consideration. 2023 ICD-10-CM Diagnosis Code R07.2: Precordial pain - ICD10Data.com Angina can be treated with lifestyle changes and medication. . It's a complication that can occur with a sternum fracture. So, what's a sternum? PDF Written By: Amanda Allen CC: "chest pain" - UNC School of Medicine Costochondritis can also occur due to injury, infection, severe coughing, physical strains, or trauma. Loffroy R, Favelier S, Pottecher P, et al. However, the common feature across all cases will be mild to severe chest pain. But Julie knows that doesn't mean Amanda is out of the woods yet. There are different symptoms of hiatal hernia, such as heartburn, frequent burping, problems in swallowing, dry cough, blood vomiting, and loss of appetite. Substernal chest pain can be symptomized by: Presence of a sour taste in the mouth or a sensation of regurgitation where that the swallowed food reenters the mouth. Furthermore, psychological therapy and cognitive behavior are also effective. Only a dr. can tell you which one do they get our quality seal of approval. Whats the Difference Between Cysts and Tumors? Opioids for acute pancreatitis pain. It is estimated that 44.9 percent of people visiting the emergency room for chest pain have acute coronary syndrome, a common cause of chest pain. different conditions from cardiac issues to swallowing problems Ghadri J-R, Wittstein IS, Prasad A, et al. Cancer in the mediastinum tissue or bronchus can also be appreciated as retrosternal chest pain. of Microbiology in a diagnostic centre in India. Save my name, email, and website in this browser for the next time I comment. The sternum, or breastbone, has three parts that are highlighted in red here. Tsai TT, Nienaber CA, Eagle KA. If this were to occur, Amanda would become pale and have low blood pressure and heart rate. Chest tightness with radiation to the left arm, Immediately life-threatening causes of chest pain, heavy, dull, pressure/squeezing sensation, often occurs as a result of excessive exercise or minor, that is reproducible on palpation of costal, Reduction of activities that provoke symptoms. - Causes, Symptoms & Treatment, What is Radiation Therapy? Free Special Report: Secret of Healthy Digestion and Regularity, Get this report FREE when you opt in for our FREE Health eTalk daily Consider urgent specialty consult and critical care unit admission. It is an inflammation of the central airways of the lungs. Substernal Chest Pain Symptoms. Rights Reserved. Although it's likely that pain behind the breastbone relates to the organs located there, such as the heart and esophagus, sometimes the pain originates elsewhere but is felt in this area. All our products are backed by a 100% satisfaction guarantee. Sternum fracture causes severe pain during coughing and inhaling. Learn how your comment data is processed. The pre-hospital management of life-threatening chest injuries: A consensus statement from the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh. Chest pain is a warning to seek medical attention. Sternum Fracture - Symptoms, Causes & Treatment - Sportsinjuryclinic.net Chest pain is a common complaint and could be a symptom of serious conditions. On EKG there will be evidence of ST elevation or depression, Q waves, or inverted T waves. Buildup of infected pus in the back of the throat. If an individual experiences pain just below the sternal bone, then it is termed as Substernal Chest Pain.Substernal Chest Pain can be quite painful and there are various factors which lead to Substernal Chest Pain, some of which can be extremely serious to include Pulmonary Embolism, Aortic Stenosis, Stable Angina Pectoris, Acute Coronary Syndrome, Myocardial Infarction, Atrial Fibrillation . Onset over minutes to hours. Pneumonia. They want to rule out the most pressing issues first, like those involving vital organs. The normal thyroid gland resides in the neck, with both lobes wrapping gently around the trachea (breathing tube).When thyroids get enlarged (called a goiter), they can grow a number of different directions. You could be dealing with GERD. 2013 ACCF/AHA Guideline for the Management ofHeartFailure: Executive Summary. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. It occurs due to trauma like a sports injury or car accident. Treatment often includes OTC medications such as Pepcid but your doctor might prescribe: Retrosternal chest pain can be a symptom of a condition affecting the heart and major blood vessels such as: Angina is chest discomfort triggered by a reduced flow of oxygen-rich blood to the heart. If you notice one or more of the signs below in yourself or someone else, call 911 or your local emergency number right away. Some types of chest pain should send you to the emergency room particularly if it lasts for at least five minutes. Devon Andre has been involved in the health and dietary supplement industry for a number of years. This is often the first step in all serious cases of chest pain. If the pericarditis is chronic, colchicine (Colcrys) could be prescribed. It does not require reentry into the retrosternal space or extensive mobilization of major pectoralis muscles. In most cases, retrosternal chest pain falls into four primary areas: Retrosternal chest pain can be a symptom of many conditions affecting the upper stomach and esophagus. R07.89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. At this time, Amanda's vital signs are stable and she's not having any other symptoms except for the pain in her sternum. Others may confuse heart attack pain with less serious problems, such as a panic attack. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement.. MacDuff A, Arnold A, Harvey J. Aortic Dissection Imaging. Chest pain is only one of the possible signs of an impending heart attack. Measurement of the sedimentation rate generally is not helpful in making the diagnosis in unusual situations, radiography may be helpful. Myocardial infarction (heart attack). Try refreshing the page, or contact customer support. A full workup, including medical history and a physical exam, will be done to rule out potential cardiac causes. Fig.1: Chest XRay of retrosternal goitre showing marked deviation of the trachea (windpipe) to left A retrosternal or substernal goitre occurs when the thyroid grows downwards from the neck into the chest. To unlock this lesson you must be a Study.com Member. However, it does not substitutes a physician, hospital or medical care facility. Khalaf M, Chowdhary S, Elias PS, Castell D. Distal Esophageal Spasm: A Review. Atrial Fibrillation with RVR (Rapid Ventricular Rate) | What is AFib with RVR? [1]. [1]. For traumatic causes of chest pain, see Blunt chest trauma and Penetrating chest trauma., The following recommendations are consistent with the 2021 American Heart Association (AHA) chest pain guidelines. Satoh K, Yoshino J, Akamatsu T, et al. Roman S, Kahrilas PJ. do they get our quality seal of approval. Consider inpatient admission if the diagnosis is uncertain or clinical suspicion of a critical cause persists. The pain may be caused by eating or drinking. Some associated symptoms include: Retrosternal chest pain treatment relies upon correctly identifying the underlying cause. Cardiac problems: By far the most worrisome complication that medical professionals want to rule out first. What causes chest congestion and how to get rid of it. Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree. The retrosternal airspace is seen as a normal lucency between the posterior aspect of the sternum and anterior aspect of the ascending aorta on lateral chest radiographs. Only after we are satisfied with the products. Get unlimited access to over 88,000 lessons. A medical condition can develop called retrosternal goiter, in which all or part of the thyroid is located behind the sternum. For this, sensors will be attached to the chest at different points to examine the heart problems. Antithrombotic Therapy for VTE Disease. These sound waves can create real-time images of the blood vessels and heart muscles. Retrosternal chest pain is pain felt behind the sternum bonea flat bone located in the middle of the chest. The chest pain may worsen with food and can awaken patients from sleep. Brenner B, Corbridge T, Kazzi A. Intubation and Mechanical Ventilation of the Asthmatic Patient in Respiratory Failure. Perhaps the most pressing determination is whether chest pain is due to acute cardiac ischemia or to nonischemic cardiovascular or noncardiac causes. Filed Under: Medical Articles and Infographics. In addition, it helps measure the leading causes of substernal pain, such as aortic dissection or pulmonary embolism. Angina - Symptoms and causes - Mayo Clinic Potential substernal chest pain causes include myocardial infarction (heart attack), pulmonary embolism, aortic stenosis, stable angina pectoris, acute coronary syndrome, atrial fibrillation, pneumonia, and severe anxiety and panic attacks, just to name a few. You have 30 days to try one bottle of the product. Learn more about acid reflux, a condition that occurs when stomach acids back up into the esophagus through the lower esophageal sphincter. A sternum fracture takes longer to heal and can take up to six months. Moreover, CT (Computed tomography) scan gives detailed images of the heart, lungs, muscles, and bones and detects abnormalities. Vege SS, DiMagno MJ, Forsmark CE, Martel M, Barkun AN. She also instructed Amanda to avoid heavy lifting, pushing, pulling, or reaching above her head until the sternum fully heals. Pulmonary embolism is a blockage such as a blood clot in one of the pulmonary arteries in your lungs. Acid reflux is typically treated with diet and lifestyle changes combined with over-the-counter (OTC) antacids like Alka-Seltzer, Maalox, Mylanta, Rolaids, or Tums. Its typically caused by acid reflux, infections, or allergies. Angina is chest discomfort triggered by a reduced flow of oxygen-rich blood to . . Location, Pain, Abscess | Gluteal fold vs Gluteal cleft, Medial Longitudinal Fasciculus Functions, Location, Lesion, Damage, Saturday Night Palsy Meaning, Definition, Symptoms, Recovery, Treatment, What is Jefferson fracture? Module 6 Health Assessment.docx - Module 6 Health Cayley WE Jr. Chest tightness with radiation to the left arm, jaw, and/or back that is associated with dyspnea should be considered cardiac chest pain until proven otherwise. Chey WD, Leontiadis GI, Howden CW, Moss SF. Generally, a retrosternal hematoma will resolve on its own in two to nine weeks. https://www.belmarrahealth.com/substernal-chest-pain-causes-symptoms-diagnosis-treatment/, https://www.medicalnewstoday.com/articles/320185, https://www.physio-pedia.com/Sternal_Pain_-_Different_Causes#, https://www.mayoclinic.org/diseases-conditions/costochondritis/symptoms-causes/syc-20371175, https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction, https://www.webmd.com/heartburn-gerd/guide/what-is-acid-reflux-disease, https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940, https://www.medicalnewstoday.com/articles/146619, https://www.epainassist.com/chest-pain/substernal-chest-pain. This is a complication experienced by about 70% of sternal fracture patients. Debra Sullivan, Ph.D., MSN, R.N., CNE, COI. Amsterdam EA, Wenger NK, Brindis RG, et al.. 2014 AHA/ACC Guideline for the Management of Patients With NonST-Elevation Acute Coronary Syndromes. for quality and safety during the production process. He practiced clinical medicine for over a decade before he shifted his focus to the field of health communications. The pain can be felt behind the breast bone. according to the number of criteria it met when substernal location, precipitation by exertion, and . Acute aortic dissection. Their use or mentioning on this website is only for informational purposes. An error occurred trying to load this video. Bel Marra products are produced A loud friction rub is appreciated over the left sternal border. The CT scan showed that she also had a retrosternal hematoma. Angina Pectoris (Stable Angina) | American Heart Association Sub-Sternal Thyroids and Goiters. - EndocrineWeb Conditions such as hemothorax (blood between the chest wall and the lung), pneumothorax (air between the chest wall and lung), pneumonia, and pleuritis are all possible causes of retrosternal chest pain. Mediastinal tumors are growths that form in the area of your chest between your lungs. Exacerbated by lying down; improved by leaning forward. Post-sternotomy pain syndrome is defined as discomfort after thoracic surgery, persisting for at . Your email address will not be published. Drugs and some surgical procedures are used to treat this type of chest pain. Type 1, Type 2, & Type 3, Ventriculostomy Procedure, Drainage, Catheter Placement, Nursing Care, Cleidocranial Dysostosis Meaning, Symptoms, Causes, Diagnosis, Treatment, Absolute immature granulocyte Test Normal, High & Low Ranges, Anterior talofibular ligament Function, Tear, Pain, Reapir Surgery, What is penoscrotal webbing (Turkey Neck) Surgery, Repair, Cost, Pupilloplasty Definition, Procedure, Recovery, Complications, Cost. liver disease. Gastroesophageal reflux/gastritis. The products released by Bel Marra Health. Coding for Chest Pain - For The Record Mag 1 . Perform a 12-lead ECG for all patients with new or evolving chest pain as soon as possible, e.g., for timely identification of acute coronary syndrome. Costochondritis: diagnosis and treatment.. Dworkin RH, Johnson RW, Breuer J, et al. Angina pain is often described as squeezing, pressure, heaviness, tightness or pain in the chest. A retrosternal goiter often causes no symptoms for years. . Dr. Marchione and the doctors on the Bel Marra Health Editorial Team are compensated by Bel Marra Health for their work in creating content, consulting along with formulating and endorsing products. Begin management of hemodynamic instability (e.g.. You can learn more about how we ensure our content is accurate and current by reading our. As for the free gifts you receive with your purchase, they are yours to keep as a thank you for giving this natural, Chest pain update: Retrosternal chest pain, chest pain that comes and goes, anxiety chest pain, http://healthncare.info/substernal-chest-pain-diagnosis-symptoms-treatment/, http://firstaidkelowna.ca/substernal-chest-pain/, Costochondritis: Common cause of chest pain, can mimic a heart attack and other heart conditions. Patients with acute thoracic aortic dissection may present with chest or back pain. When the heart is compressed, it cannot pump enough blood and can result in decreased blood pressure and a depressed heart rate. Mayo Clinic Staff. This creates a cage of protection around vital organs such as your heart and lungs. Moreover, acid reflux causes heartburn disease, bloating, burping, dry cough, nausea, or breathing issues. Recurring substernal chest pain that is not due to cardiac disease is a common clinical problem [].Recurrent unexplained chest pain can significantly impact patient quality of life and represents a major economic burden because of continued utilization of clinical resources and emergency facilities [].This topic will review the pathophysiology, etiology, and evaluation of chest . Due to the relative location of substernal pain, it is often confused with a variety of different medical conditions, which can induce unnecessary anxiety in sufferers. The treatment of substernal chest pain initially relies on the patients cardiac causes and symptoms. the breast bone. To accurately assign an ICD-10-CM code for a Myocardial Infarction, coders will need to know both the wall and the artery involved in the Myocardial Infarction. to a cardiac care unit to compare the severity of chest pain in ACS vs nonischemic groups and found . Treatment for esophagitis is based on the underlying cause and the amount of tissue damage already sustained. Any case of substernal chest pain should not be ignored, as it can be difficult to say for sure that it is due to a serious or non-serious cause. (n.d.). He has a Bachelor of Forensic Science from the University of Windsor, and went on to complete a Juris Doctor from the University of Pittsburgh. This space normally measures less than 2.5 cm in width. Publicado en junio 16, 2022 por junio 16, 2022 por In more common causes of substernal chest pain, such as acid reflux, the use of medications to reduce stomach acid is commonly implemented. Rarely, a thyroid will grow downward into the chest. These injuries often occur in car accidents or sports accidents and are becoming less common as safety technology advances in vehicles. Moreover, doctors can prescribe a combination of medicines like Pepcid, Prevacid, Nexium, Aciphex, or Protonix. What is the Difference Between SIRS & Sepsis? adjective describing the anatomical area below, beneath or behind All rights reserved. Kearon C, Akl EA, Ornelas J, et al. caused by a yeast infection in the throat, hiatal hernias or Sreide J, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. A 52-year-old man presents to the Emergency Department via ambulance with substernal chest pain. A substernal/retrosternal goiter is therefore a large thyroid that has grown so big that it has grown out of the neck and into the area of the chest. These goiters can push and displace the breathing tube, swallowing tube and important blood vessels in the neck . Leech C, Porter K, Steyn R, et al. | Designed and Developed by, Substernal Chest Pain Diagnosis, Symptoms, Treatment. Patients presenting with substernal or left chest pain with radiation to the left arm had a less than 10% chance of having right coronary artery disease. Hyperresonance on percussion, decreased breath sounds, Hyperresonance on percussion, decreased breath sounds on the affected side, Diffuse wheezing, decreased breath sounds, Dullness to percussion, decreased breath sounds, decreased, History of recent endoscopy or severe emesis (, Symptoms aggravated by stress and/or hot and cold food and drink, No associated esophageal symptoms (e.g., no. Chronic lung diseases, including diseases of the pleura, the tissue that covers your lungs. - Definition, Symptoms & Surgery, Listeria Monocytogenes: Symptoms & Treatment, What is an MRI Scan? However, due to the nature of the pain and its presenting symptoms, those who experience retrosternal pain will often be worked up to rule out any potential cardiogenetic cause. Typical treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs). Substernal chest pain usually can be diagnosed by history and physical examination if other etiologies have been excluded. The treatment for Substernal Chest Pain solely depends on the underlying cause of the pain. This is the American ICD-10-CM version of R07.89 - other international versions of ICD-10 R07.89 may differ. It can be squeezing or pressure-like. Biliary colic. The symptoms of a heart attack may include chest pain, shortness of breathing, abnormal fatigue, nausea, or dizziness. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. Substernal chest discomfort of characteristic quality and duration; Provoked by exertion or . Retrosternal Goitre - Endocrinesurgery.net.au What is substernal chest pain? - KnowledgeBurrow.com Localised pain which does not radiate. Sign up and get unlimited access. Heart attacks, heart fibrillation, pericarditis, angina, and mitral valve prolapse are all problems that can mimic more benign causes of retrosternal chest pain. substernal vs retrosternal chest pain. Evidence. Since Amanda had undergone imaging tests, they had ruled out these other injuries. However, using your better judgment and recognizing that your particular cause is not normal will be the first step in recovery. It can last from a few seconds or minutes to many hours. Suggested by: continuous pain, usually over 30 minutes, not relieved by rest or antianginal medication. Substernal chest pain: Causes, symptoms, diagnosis, and treatment. In many cases this growth can be slow, enlarging over a period of years and gradually pressing on structures such as the esophagus. Many other structures lay beneath the sternum such as the heart, blood vessels, and the esophagus, all of which may be compromised in some way. The features that physicians rely on are associated symptoms that often accompany . Kreuter M, Mathis G. Emergency ultrasound of the chest.. Mavroudis CD, Kucharczuk JC. Rights Reserved. Up to 20% of patients have breathing difficulties and pain coughing or sneezing. Viruses commonly cause acute bronchitis, while smoking may cause chronic bronchitis. Sometimes if the medications are not effective surgery such as angioplasty or bypass surgery is recommended. It improves if the patient sits upright or leans forward. Joint injury symptoms include swelling or mild pain in the upper chest and difficulty in shoulder movement. Stomach problems, such as ulcers. Basurto Ona et al. Chest Retractions While Breathing: Symptoms, Causes, and Types - WebMD - Definition, Types & Side Effects, What Is Sarcoma? Substernal Chest Pain|Causes|Symptoms|Treatment|Diagnosis The physiologic explanation for this may be that esophageal pathology typically induces retrosternal pain as well. It is comprised of three parts; the manubrium, the body, and the xiphoid process. Furthermore, an echocardiogram can be used to measure other cardiac abnormalities by using sound waves. Substernal and retrosternal mean the same thing,: its an Hooper et al.. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Global Initiative for Chronic Obstructive Lung Disease. Several muscles have been connected to ribs and sternum. If the retrosternal hematoma had been larger and compressed her heart, she would have required surgery to remove the hematoma to relieve the pressure off of her heart and to restore adequate circulation. - Causes, Symptoms & Treatment, What Is Gingivitis? Leigh-Smith S, Harris T. Tension pneumothorax--time for a re-think?. This pain is most often experienced by people with ailments or injuries related to the heart, lungs, thyroid, or trachea. Chest pain: A heart attack or something else? - Harvard Health A bad . Amanda remains stable and after a couple of days in the hospital, she is discharged home. Moreover, pleurisy has been caused by bacterial infections like pneumonia or viral infections. When the results were back, he told her she had a fractured sternum and sent her to have a CT scan. Rosh Cardiology Set 2 Flashcards | Quizlet Blood tests will be done to check cardiac enzymes within the blood. Retrosternal means behind the breastbone, or sternum. Angina (an-JIE-nuh or AN-juh-nuh) is a type of chest pain caused by reduced blood flow to the heart. Kim H-S. Endoscopic Management of Mallory-Weiss Tearing. The patient was a 57-year-old female, who visited our hospital for surgical treatment for a large substernal goiter. Pain, numbness, pinching, prickling, or . This can be life-threatening and would require emergency intervention. Due to the nature of the injury, the blunt force trauma that broke the sternum likely may have broken ribs or caused injury to the heart or lungs. Differential diagnosis for retrosternal chest pain It has been a pretty slow day but dispatch just notified her that there has been a motor vehicle accident. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Thyroid mass: substernal goiter remains a significant consideration in the differential diagnosis of mediastinal masses, particularly those located in the anterior mediastinum. Symptoms could include new or unexplained chest pain coupled with shortness . Substernal vs retrosternal chest pain. Chest pain and cough can have a simple cause, like the flu. The sternum is a bone located at the center of the chest, connected to the ribs by cartilage. Begin management of hemodynamic instability (e.g., shock, hypertensive emergency), signs of respiratory distress, and/or respiratory failure (e.g., hypoxia, hypercapnia) as soon as they are identified. Her retrosternal hematoma was small in size and did not compromise her heart. Also known as pleuritis, pleurisy is caused by inflammation of the pleura the lining around the lungs. Patients with red flag features suggestive of life-threatening causes (e.g., acute coronary syndrome, pulmonary embolism) and those who are hemodynamically unstable require immediate assessment. substernal vs retrosternal chest pain - ellinciyilmete.com This is the initial step among all chest pain infections to sort out cardiac causes. Chest pain is classified to ICD-9-CM code 786.50, which may change depending on the exact location, with midsternal or substernal chest pain coded to 786.51 and chest wall or anterior chest wall pain coded to 786.52.
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substernal vs retrosternal chest pain
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