Dr.Semmals Letters related to Psychosomatic Medicine to his Daughter - Letter 1

Letter – 1

Dear Daughter,

As u were crossing the wards and interacting with real patients u r mind is ought to get a lot of intriguing questions related to the Basic Sciences, I am always there to help u to clarify them then and there. 

The other day u have been asking to me about a question, Why is Chest Pain so serious of a problem?

I would like to answer u about it now.

Its serious b’cos it can kill u r patient, but all pain  in the chest r not always from the heart, u need to know this.

Pain, u may even call it as discomfort in the chest is a cardinal  manifestation of ischemia involving the myocardium.

Now u need to know what does the word Cardinal means ?

The Word Cardinal means – of Foremost Importance – of paramount importance

Just wait – do u know that is the non medical meaning of the word Cardinal ?

It means sanctae romanae ecclesiae cardinalis( Latin) an ordained Bishop in the Roman Catholic Church.

Coming back to the problem of chest pain, it is quiet serious when it arises due to a reason involving the Myocardium. It can b due to dis ease in the coronary artery. Even when the arteries are fine as u believe yours to be – still there can be an imbalance which could lead to Myocardial Ischemia.

What is the Imbalance? - this imbalance is related to myocardial oxygen demand, when the supply is less compared to the need for myocardial oxygen, something akin to the status of the money balance tagged to u r ATM card at the end of the month, still  God has blessed u with many collateral's.

I mean u r good friends, who could give u the extra feed in times of need. 

When a patient comes to u with chest pain – First rule out it’s not from the heart, as it’s very dangerous.

Now u may ask me, can there be any reason beyond the heart to get it?

Lot may b there,

Apart from the Myocardium, It can b due to 

Dissection of the Aorta

From the Lungs (Pulmonary embolism - Pleural irritation)

Musculoskeletal origin from the chest wall, thorax, or shoulder

Gastrointestinal abnormality as due to reflux (stomach contents moving in reverse towards the esophagus – quiet horrible isn’t it)

Spasm of the Esophagus

Peptic ulcer disease

Cholecystitis

Now, what is Cholecystitis ?

“Chole” – means Gall Bladder

“Itis” – denotes Inflammation