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Dor torácica


Constitui uma das principais causas pelas quais as pessoas procuram cuidados médicos urgentes. Geralmente a primeira preocupação do paciente é saber se está perante um problema cardíaco, ex: enfarte do miocárdio. Felizmente, nem sempre a dor torácica implica um problema cardíaco. Qualquer órgão ou tecido localizado no tórax pode ser a causa da dor, pulmões, esófago, músculos, costelas, tendões ou nervos, além do coração. Contudo, mesmo que a dor torácica não provenha de um problema cardiovascular pode ser um sinal de outra patologia, que também poderá ser grave, pelo que a procura de cuidados médicos é essencial.


O que considerar como dor torácica?

Qualquer dor ou desconforto localizado na parte da frente do corpo, entre o pescoço e o abdómen, barriga.


Quais as principais causas de dor torácica?


Causas cardíacas:

- Ataque cardíaco (Enfarte Agudo do Miocárdio): sempre que ocorre uma interrupção do fornecimento de sangue e oxigénio ao coração, geralmente por oclusão de uma ou mais artérias coronárias (vasos sanguíneos que conduzem e distribuem sangue pelo músculo cardíaco). A dor é frequentemente semelhante à da angina de peito mas com maior intensidade e duração, descrita como um aperto, opressão, peso na região central do peito (dor constritiva). Essa dor ou desconforto pode irradiar (alastrar-se) para o queixo, costas, ombros e braços (principalmente o esquerdo). Pode surgir associada a outros sintomas como falta de ar, tonturas, suores frios, náuseas e vómitos.

- Angina de peito: surge sempre que o músculo cardíaco não recebe sangue e oxigénio em quantidades suficientes. A angina de peito que algumas pessoas padecem é despertada pelos esforços físicos ou por situações de stress emocional (podendo também ser induzida pelo frio). Consideram-se dois tipos de anginas, estáveis, sempre que são despertadas pelo mesmo grau de esforço ou estímulo habitual, e instáveis, quando surgem de formas inesperadas, aquando um esforço mais ligeiro, ou em repouso (esta é a forma mais perigosa de angina e implica uma observação médica urgente).

- Outras causas cardiovasculares: a inflamação do pericárdio (“saco” que envolve o coração), pericardite. É uma dor geralmente aguda, fraca, na região central do peito, que é caracteristicamente agravada quando o doente se deita de barriga para o ar, melhorando com a posição de sentado. É geralmente auto-limitada no tempo e está na maior parte das vezes associada a uma infecção vírica; Uma causa rara mas muito grave de dor torácica é a dissecção aórtica, ocorre quando as paredes da artéria aorta se separam e sofrem um “rasgão”, passando o sangue a correr entre as mesmas, aumentando esse mesmo “rasgão”. A dissecção aórtica pode surgir após traumatismo do tórax ou estar associada a hipertensão arterial mal controlada. A dor é descrita como intensa, localizada das costas ou peito, sentida, muitas das vezes, como alguma coisa a “rasgar-se dentro do peito”.


Causas não-cardíacas:

- Asma: falta de ar, pieira e tosse;

- Pneumonia (infecção afectando os pulmões);

- Embolia pulmonar (coágulo de sangue numa veia pulmonar); pneumotórax (colapso de uma porção do pulmão); pleurisia (infecção da membrana que reveste os pulmões). Frequentemente nestes casos a dor agrava-se com a inspiração profunda e a tosse e é singularmente aguda;

- Inflamação ou estiramento dos músculos e tendões das costas;

- Zona afectando a parede torácica – devido a lesões cutâneas características com aspecto avermelhado, bolhas e vesículas.

- Ansiedade e hiperventilação (ataques de pânico).

A dor torácica também pode estar relacionada com problemas localizados no tracto digestivo, úlcera gástrica, patologia da vesícula biliar, litíase biliar (areia nas vias biliares), indigestão, azia, refluxo gastroesofágico (quando o ácido do estômago passa para o esófago). A dor relacionada com uma úlcera é geralmente tipo ardência e não melhora após uma refeição. A dor associada a uma patologia biliar piora após uma refeição, principalmente se for rica em gorduras. A dor relacionada com as estruturas da parede torácica (músculos, costelas e nervos) surgem geralmente após algum tipo de traumatismo, esforço ou tosse intensa, a dor é muitas das vezes localizada e despertável com a pressão sobre o local afectado. Frequentemente, estas situações não são graves e podem ser tratadas recorrendo a analgésicos, anti-inflamatórios, gelo e repouso.


O que fazer face a uma dor torácica?

Razões para chamar os serviços de emergência médica:

- Dor súbita constritiva;

- Se a dor irradiar para o maxilar, queixo, braço esquerdo ou para as costas na zona entre os omoplatas;

- Se para além da dor sentir náuseas, tonturas, sudação (produção de suor) excessiva, palpitações (sensação do coração a bater depressa ou de forma irregular) ou falta de ar;

- Se for um doente que sofra de angina de peito mas a dor for inesperada, mais intensa ou durar mais do que o tempo habitual.

- Se a dor for súbita e aguda associada a falta de ar especialmente após um determinado período de imobilização (ex: após uma longa viagem, após uma cirurgia).

Caso não se verifique nenhuma das circunstância acima definidas, o seu médico assistente deverá ser informado se a dor torácica foi associada a febre ou a tosse com expectoração amarelada ou esverdeada. Se a dor torácica persistir por mais de três a cinco dias, deverá consultar o seu médico.


O que esperar na avaliação médica?

Nos serviços de urgência se necessário serão implementadas medidas emergentes para suporte de funções vitais. Na maioria dos casos, será submetido a um exame físico orientado sobretudo para a parede torácica, coração e pulmões, e os sinais vitais (pulso, temperatura, frequência respiratória, pressão arterial) serão avaliados/monitorizados. Alguns exames complementares: ECG em repouso, que poderá ter que ser repetido, analises ao sangue que incluem os chamados marcadores de necrose do miocárdio (proteínas que são libertados pelas células do coração na corrente sanguínea quando há lesão cardíaca), radiografia ao tórax, prova de esforço, ecocardiograma, cateterismo cardíaco, endoscopia digestiva alta. Após oito a doze horas desde o início dos sintomas as análises ao sangue poderão ter que ser repetidas. Poderá ser necessário internamento caso se confirme patologia com gravidade (enfarte agudo do miocárdio, aneurisma da aorta, pneumonia, etc.) ou em caso de dúvida no diagnóstico.

Posted by Immuniselectrun at 08:03

Hall of fame

Louis Pasteur

Birthday date: 27th December, 1822

The truth is surprising: as young, Louis Pasteur was a lazy student. His teachers never thought he was quite clever, as ahead he would show.

He studied physics and chemistry in Paris and chemistry was even the discipline in which we got a lower grade. Despite of that, later, He became a wise teacher and was one of the bigger scientists of ever, a genius of science. Only through one huge thirst of knowledge and an inexhaustible will of work the immortality was conquered and the death was defeated.

Facing all the expectations, the success arrived much early. With twenty six years he discovered the secret of crystals and a few time later he realized that the air we breathe it’s full of very small beings, He called them the invisible giants. Perhaps Pasteur already knew that these beings, apparently armless, were responsible for much part of the diseases shown in living beings. For sure he knew that the microorganisms used to enter in our organism with the purpose of unleash diseases. It was not easy to prove such theory in a time when all scientists thought that microorganisms were fruit of our own organism and not from outside. He wouldn’t give up anyway, He even bottled air to prove it, under the laugh of his colleagues , of course they didn’t even guess that what he was doing would become indispensable to his theory: none living being, including microorganisms, can appear in the world without descend from at least other of the same specie. In the course of his experiences, Pasteur could show up that microorganisms live in the air and reproduce themselves, entering in our body when they “feel” we are weakened and is the best shot to take. This was a very important discovery but his greatest feat, vaccine, would take more time to be created.

Before it, he helped the French farmers, solving a big problem: the quick sourness of wine. He observed microscopically the wine and found some kind of very short vegetation, called yeasts. Therefore, the yeasts were spoiling the wine, making it vinegary. Pasteur understood that wasn’t possible to take out those little creatures, they had to be killed and the only possible way: heat them up. The problem lied in the fact that the wine couldn’t heat up to high temperatures because it would change its quality. Persistent, Pasteur made a lot of experiences and found the solution: it was only necessary rise the wine’s temperature about sixty degrees centigrade to kill the microorganisms. These experiences gave rise to a much known process called pasteurization.

Pasteur was, undoubtedly, a chemistry genius and started to be called to solve the riddles that more nobody could. There was even a time when he was asked to find the origin of a plague which was killing thousands of silkworms. Pasteur, after some research, figured out that the butterfly was transmitting to her own eggs the disease and hence died so many of them. It was necessary to exterminate all larvae, butterflies and eggs which weren’t healthy. He had saved the French Industry of Silk and now, he’s stories of success were told not only in France but also abroad.

Modest, simple and not vain, Pasteur used to say that he only worked to help mankind. But, the fact of two of his sons have died with typhoid fever explain the dedication to Medicine and to studies about diseases caused by microorganisms.

Carbuncle was one of the first diseases studied by Pasteur. In that time, were dying many animals, mostly sheep due this disease. He discovered the responsible microorganism and made an experience: vaccinated twenty five sheep with the germ which caused the disease and left other twenty five sheep for vaccinate. Then he infected them all with the microorganism which made they feel sick. Happened that all vaccinated sheep survived and the others died. This was the first success of vaccination. However, he refused money to patent the medicine.

He wondered if would be worthwhile try to apply the same principles in the cure of human diseases. About 1880 Pasteur started to study the rage disease (affect animals, especially dogs, and normally is transmitted to humans by a nibble). Firstly, he discovered the rage virus. Then he used its “good” part to create an antidote and transformed it into a vaccine. Later, He started to inoculate it in the dogs but he didn’t have the courage to do the same in humans, until when on 6th July, 1885, a woman knocked on his door. She was carrying a boy with nine years old that was bitten by a dog fourteen times. The mother begged him to heal her son but the scientist didn’t want to experiment the serum in the kid named Joseph Meister because so far he never had used the vaccine in humans. However, once there was no other solution, eventually the kid would die with or without the inoculation, he applied the first of twelve anti-rage vaccines. During many weeks, the scientist and boy’s family feared the worst but in the end, Joseph Meister survived. From that time, people that had been bitten by raged dogs started to go to his laboratory asking for help. They came from different places of France and even from abroad although doctors didn’t recognize the worthwhile of Pasteur, what’s unthinkable, even because before his investigations, the only medicine available against rage was a spike in hot coal to burn the dog’s bite.

The vaccines were a huge triumph to medicine. Without them it’s difficult even think in survival.

Pasteur Institute:

The success of anti-rage vaccine was so enormous that the French Academy of Sciences decided to build one Institution dedicated only to laboratorial investigation. The Pasteur Institute was established in 1888 and is nowadays one of the most known centers of scientific investigation.

Curiosity – The HIV virus was isolated for the first time in these laboratories. This Institution without profitable ends was presided by Louis Pasteur until his death (28th September, 1895) and has a team of scientists that globally has eight Nobel Prizes in Medicine.

Microscope:

Nobody knows for sure who created it. Generally, its invention is attributed to Hans Janssen, Dutch glasses manufacturer, and his son Zacarias, in the year of 1590. However, will have been the Dutch Anton van Leeuwenhoek, that lived between 1632 and 1723, who made the first microscopic observations. He was a textile trader that used to mount lends. It was precisely through curved glasses that he mounted in a rudimental microscope that he saw little creatures which were walking along the drops of rain, vinegar and saliva. He was not a scientist but woke up the interest of scientific community. The first microscope had only one lend and so it couldn´t amplify very much.