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Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chest pain is a common complaint in the primary care setting. During the evaluation of this complaint, most efforts are directed toward eliminating the most serious causes of chest pain. Despite a complete evaluation, many patients never receive a formal diagnosis for their complaints, which can lead to frustration and continued symptoms, which can in turn affect mission readiness of a unit. We report on a patient who presented to sick call during his deployment with a rather unexpected finding.
Mil Med 2009 Nov
PMID:Chest pain in a young soldier. 1996 Aug 36

A previously healthy 20-year-old male trainee developed chest pain, shortness of breath, and neck pain after repeatedly shouting "Hooah!" during a motivational squad competition. He was found to have developed a pneumomediastinum with soft tissue crepitus of the neck. He had an uneventful recovery. Unique to the military training environment, vigorous shouting, including "Hooah!" as a motivational stimulus, can have barotraumatic consequences. The term "spontaneous" as applied to a pneumomediastinum diagnosis is examined and the auscultatory finding of "Hamman's sign" is reviewed.
Mil Med 2011 Mar
PMID:"HOOAH!" A case of pneumomediastinum in the military training environment; Hamman's sign 71 years later. 2145 67

Chest pain is a common complaint at medical treatment facilities during combat operations. The initial evaluation focuses on potentially life-threatening conditions (acute coronary syndrome, aortic dissection, pulmonary embolus), in addition to pericarditis and benign musculoskeletal conditions such as costochondritis. Pulmonary arteriovenous malformation is a rare condition, but an important diagnostic consideration in soldiers who present with chest pain and/or hypoxia and in whom other life-threatening conditions, such as cardiovascular disasters and pulmonary embolus, are excluded. We present the case of a male soldier deployed to Operation Iraqi Freedom, who was air-evacuated back to Washington, DC, for definitive care. We present his case and a review of the relevant literatures on the diagnosis and treatment of patients with pulmonary arteriovenous malformations.
Mil Med 2011 Apr
PMID:An uncommon cause of chest pain in the deployed soldier. 2153 64

After an 18-hour bus ride, a 29-year-old soldier complained of leg pain. Ten days later, he collapsed. After cardiopulmonary resuscitation (CPR), he revived but complained of chest pain and shortness of breath. Computed tomography revealed massive thrombus in the right pulmonary artery, emboli in the left pulmonary artery, and right ventricle ballooning. Adequate anticoagulation required repeated boluses and continuous infusion (1,600 units/hour) of heparin. Vena caval filter was not available, and possible additional clot in the legs could not be completely assessed. After no improvement in 24 hours, alteplase was given (10 mg IV bolus and 90 mg over 2 hours). At 12 hours, tachycardia, tachypnea, and dyspnea resolved and computed tomography revealed marked resolution. This case illustrates both the value of CPR and aggressive fibrinolytic therapy in patients who suddenly collapse from massive pulmonary embolism. The collapse was likely due to a saddle embolus. Chest compressions probably fractured the large clot. Although not completely reestablished, enough flow occurred for successful resuscitation. Even though delayed, fibrinolytic therapy was effective and should be considered even in patients where vena caval filter placement is not feasible and/or complete evaluation of the extremity deep venous system is not possible.
Mil Med 2011 Dec
PMID:Treatment of massive pulmonary embolism in a soldier in Kosovo: the potential value of cardiopulmonary resuscitation and fibrinolytic therapy. 2233 66

Acute aortic dissection is one of the most devastating and time-sensitive diagnosis to consider in young adults with chest pain. Military medicine is represented by a larger proportion of 18- to 50-year-old individuals than is seen in the general medical population. Although uncommon in frequency, younger patients are more likely to suffer from proximal, aortic dissections. Chest radiographs and D-Dimer assays are used frequently as risk stratification tools, but have significant limitations in these more proximal dissections. Because of the frequency and lethality of nonspecific presentations, there exists a need for a sensitive screening tool. This case report presents a 43-year-old male with a concerning history and physical examination for aortic dissection, but a normal portable chest radiograph and a normal D-Dimer assay. It highlights the importance of clinical acumen in developing and maintaining a high clinical index of suspicion based on a Bayesian pretest probability model.
Mil Med 2015 Jan
PMID:Acute, proximal aortic dissection with negative D-Dimer assay and normal portable chest radiograph: a case report. 2556 79

Gastrointestinal problems are common during wars, and they have exerted significant adverse effects on the health of service members involved in warfare. The spectrum of digestive diseases has varied during wars of different eras. At the end of the 20th century, new frontiers of military medical research emerged due to the occurrence of high-tech wars such as the Gulf War and the Kosovo War, in which ground combat was no longer the primary method of field operations. The risk to the military personnel who face trauma has been greatly reduced, but disease and non-battle injuries (DNBIs) such as neuropsychological disorders and digestive diseases seemed to be increased. Data revealed that gastrointestinal symptoms such as constipation, diarrhea, dyspepsia, and noncardiac chest pain are common among military personnel during modern wars. In addition, a large number of deployed soldiers and veterans who participated in recent wars presented with chronic gastrointestinal complaints, which fulfilled with the Rome III criteria for functional gastrointestinal disorders (FGIDs). It was also noted that many veterans who returned from the Gulf War suffered not only from chronic digestive symptoms but also from neuropsychological dysfunction; however, they also showed symptoms of other systems. Presently, this broad range of unexplained symptoms is known as "Gulf War syndrome". The mechanism that underlies Gulf War syndrome remains unclear, but many factors have been associated with this syndrome such as war trauma, stress, infections, immune dysfunction, radiological factors, anthrax vaccination and so on. Some have questioned if the diagnosis of FGIDs can be reached given the complexity of the military situation. As a result, further studies are needed to elucidate the pathogenesis of gastrointestinal disease among military personnel.
Mil Med Res 2015
PMID:Gastrointestinal problems in modern wars: clinical features and possible mechanisms. 2630 Nov 1

Myopericarditis following smallpox vaccination is a documented side effect with increasing incidence since reestablishing mandatory vaccination for deploying military personnel. After the ACAM2000 smallpox vaccine replaced the Dryvax smallpox vaccine, the rate of myopericarditis increased 50-fold.We describe six case reports of active duty soldiers who presented to the emergency department complaining of chest pain shortly after receiving routine pre-deployment vaccinations to include smallpox. All were hospitalized and became non-deployable after developing smallpox vaccination-associated myopericarditis.Some cases of smallpox vaccination-associated myopericarditis are diagnosed in soldiers in austere environments, which have led to the soldier being removed from the mission for months at a time. This can be avoided by having all soldiers who receive the smallpox vaccine screened for clinical evidence of myopericarditis at 30 days after receiving the vaccine. Contributing to the increasing rate of myopericarditis as well as the negative impact on soldier medical readiness, the continued use of the current ACAM2000 smallpox vaccine should be monitored.
Mil Med 2019 01 01
PMID:A Case Series of Smallpox Vaccination-Associated Myopericarditis: Effects on Safety and Readiness of the Active Duty Soldier. 2994 93

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndromes, which has been gaining increased recognition with the routine use of coronary angiography and intravascular imaging techniques in patients presenting with ST-elevation myocardial infarction. Here we report the case of a healthy, 26-year-old active-duty male presented to Tripler Army Medical Center for evaluation of acute onset and worsening chest pain that occurred shortly after participating in an Army physical fitness test. His initial EKG demonstrated a myocardial injury pattern with ST elevations in leads V1-V4. Invasive angiography revealed thrombotic occlusion of the proximal left anterior descending coronary artery with no evidence of atherosclerotic disease by intravascular ultrasound imaging. SCAD was suspected, and this diagnosis was confirmed after eptifibatide-induced propagation of the dissection plane resulting in recurrence of his index chest pain. To our knowledge, this is the first reported case of SCAD in the active-duty military population. SCAD is a rare, but important, cause of acute coronary syndromes that must be recognized by military providers as it necessarily precludes further military service.
Mil Med 2019 05 01
PMID:Spontaneous Coronary Artery Dissection in a 26-Year-Old-Male Soldier. 3021 93


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