Lesson 6:-
Although the first thought in a football player with acute chest pain is usually towards cardiac causes, there are a number of life-threatening, non-cardiac, conditions that present with acute chest pain that need to be considered. It should be noted that football players with a potentially life-threatening cause of chest pain may appear initially relatively well, showing neither vital sign nor physical examination abnormalities. However, whatever the source of the chest pain may be, healthcare providers should always focus on the immediate detection of common life-threatening causes of chest pain and treat accordingly.
Primarily, “non-cardiac” causes of acute chest pain can to be differentiated by the origin of the pathology. Some of these non-traumatic, non-cardiac life-threatening medical emergencies are listed below and are included mainly for information and completeness.
Acute aortic dissection:-
The most critical cause of severe aortic-type chest pain is acute aortic dissection. In a football player, this would usually be due to congenital abnormalities, hypertension or connective tissue disease. One example would be a dissection which occurs in a player with Marfan syndrome. The event that may precede a fatal tear or dissection may be due to simple blunt trauma to the chest.
Acute pulmonary embolism:-
Although pulmonary embolism (PE) is thought to be a rare life-threatening field-of-play medical emergency, the exact incidence is unknown. However, its existence is always possible because of the frequent travel, that may increase the risk of PE above that of normal.
Exercise-induced bronchospasm:-
While shortness of breath and wheezing are more common symptoms associated with exercise-induced bronchospasm (EIB), players may also experience chest pain. This diagnosis is considered in more detail in the respiratory module.
Tension pneumothorax:-
A tension pneumothorax is a medical emergency. In a football setting, it is frequently associated with a rib fracture. The presentation and management of this condition is considered in more detail with “chest injuries” later in this module.
Inflammatory or infectious:-
Pleuritis, pneumonia, bronchitis and mediastinitis are rare on the field of play because signs and symptoms would have presented prior to the match or competition.
Treatment
Player should be removed from the field of play and advised against further physical exercise. They may require analgesia or antipyretic drug therapy. They should be treated symptomatically and transferred urgently to the nearest, most appropriate medical facility if clinically unstable.
Acute gastrointestinal conditions:-
As the cardiac system and the oesophagus share some common neurologic innervations, acute pathology in either system can present with classical symptoms of chest tightness, provocation by exercise and pain-release by rest or nitrates.
As such, it may be difficult to distinguish clinically between cardiac chest pain and pain originating from the gastrointestinal system. Common, or more significant, gastrointestinal conditions include gastro-oesophageal reflux, oesophageal spasm, oesophagitis and spontaneous oesophageal rupture.
Symptoms and signs
Players with gastrointestinal conditions may experience chest pain, painful swallowing, tachypnoea or dyspnoea. Cyanosis, fever and shock may develop rapidly when there is a more significant problem.
Treatment
The player should be removed from the field of play and advised against further physical exercise. One should obtain intravenous access and administer fluids as required. The player should otherwise be treated symptomatically and, if clinically unstable, transferred urgently to the nearest, most appropriate medical facility.
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Jatin Tyagi 