VERTEBROGENIC CHEST PAIN – »PSEUDOANGINA PECTORIS«: ETIOPATHOGENESIS, CLINICAL MANIFESTATIONS, DIAGNOSIS, DIFFERENTIAL DIAGNOSIS AND THERAPY
Autori:
Vjekoslav Grgić
Sažetak
Sažetak. Vertebrogena bol lokalizirana u prednjem dijelu prsnog koša može oponašati anginoznu bol (»pseudoangina pektoris«). Najčešći uzroci vertebrogene boli u prsima su segmentalna disfunkcija i degenerativne promjene u razini donje vratne i srednje-gornje prsne kralježnice. Segmentna disfunkcija izvorište je pseudoradikularne boli, a degenerativne promjene, prije svega hernija diska i stražnji osteofiti koji pritišću odgovarajuće živčane korjenove, izvorište su radikularne boli koja zrači u prsa. Zbog sličnosti s anginom pektoris, jaka bol u prsima uzrokovana cervikalnom radikulopatijom, koja je često praćena smetnjama srčanog ritma i nespecifičnim promjenama ST-T-segmenta u EKG-u, nazvana je »cervikogena angina«. Napadaji vertebrogene boli u prsima nisu rijetki ni u bolesnika s anginom pektoris. Zbog superponiranja vertebrogene boli, manifestacija boli u bolesnika s anginom pektoris može biti znatno izmijenjena, što se može pogrešno interpretirati kao nestabilna angina. S terapijskog aspekta vrlo je važno razlikovati vertebrogenu od anginozne boli. Naime, promjena kardiološke terapije neće ukloniti eventualne napadaje vertebrogene boli u bolesnika s anginom pektoris. U članku su s aspekta najnovijih spoznaja opisane etiopatogeneza, karakteristike, dijagnoza, diferencijalna dijagnoza i terapija vertebrogene boli u prsima te razlike između vertebrogene i anginozne boli.
Summary
Summary. Vertebrogenic pain localised in the anterior thorax can imitate anginal pain (»pseudoangina pectoris«). The most common causes of vertebrogenic chest pain are segmental dysfunction and degenerative changes at the level of the lower cervical and upper middle thoracic spine. Segmental dysfunction is a source of pseudoradicular pain, and degenerative changes, before all disc hernia and dorsal osteophytes which are compressing corresponding nerve roots, are the sources of radicular pain which irradiates in the chest. Because of its similarity with angina pectoris, the intense chest pain caused by the cervical radiculopathy which is often followed by heart rhythm disorders and nonspecific changes of the ST-T- segment in ECG, is called »cervicogenic angina«. The attacks of vertebrogenic chest pain are not rare even in patients with angina pectoris. Because of superimposed vertebrogenic pain, the manifestation of pain in patients with angina pectoris can be considerably changed which can be misinterpreted as unstable angina. From therapeutic aspect it is very important to distinguish vertebrogenic from anginal pain. That is, the change of cardiological therapy will not eliminate possible attacks of vertebrogenic pain in patients with angina pectoris. From the aspect of most recent understandings, the article describes etiopathogenesis, characteristics, diagnosis and therapy of vertebrogenic chest pain, and also the differences between vertebrogenic and anginal pain.
