CASE 2
CHEST PAIN
胸痛
History
A 34-year-old male accountant comes to the emergency department with acute chest pain.
emergency department 急诊室，emergency room 这种用法更常见，但是两者都可
acute急性的，与之相反的是chronic 慢性的，上一章中出现了一个词表示缓慢的（详见系列1），但是不能表达疾病持续很长时间或迁延不愈，所以在翻译医学材料时，尽可能使用上述这一对搭配。
There is a previous history of occasional stabbing chest pain for 2 years. The current pain had come on 4 h earlier at 8 pm and has been persistent since then. It is central in position, with some radiation to both sides of the chest.
radiation 放射（至），注意与牵涉痛（referred pain）区别，两者不一样，←欲知详情，找我小灶，或关注此系列后续内容。
It is not associated with shortness of breath or palpitations. The pain is relieved by sitting up and leaning forward. Two paracetamol tablets taken earlier at 9 pm did not make any difference to the pain.
气短；扑热息痛（主要成分为对乙酰氨基酚，可解热镇痛抗炎）
The previous chest pain had been occasional, lasting a second or two at a time and with no particular precipitating factors（诱因）. It has usually been on the left side of the chest although the position had varied.
Two weeks previously he had an upper respiratory tract（上呼吸道） infection which lasted 4 days. This consisted of a sore throat, blocked nose, sneezing and a cough.
sore throat为固定搭配，可以用throat pain，有人使用，但是不推荐，就好比我们通常说衣服破了，而不说衣服漏了，可以是可以，但是有一点点奇怪。
His wife and two children were ill at the same time with similar symptoms（症状） but have been well since then.
医学中注意区分症和征，症状可以是头痛，恶心，呕吐等，无需检查就能判断出来，而征一般需要检查，如发热，需要测量体温得出，etc.*所以综合征和综合症也是不一样的。
He has a history of migraine（偏头痛）. In the family history his father had a myocardial infarction at the age of 51 years and was found to have a marginally high cholesterol level.
myo—前缀，表示和肌肉有关的，cardio—前缀，和心脏有关，myocardial infarction 心肌梗塞，注意与心肌缺血（ischemia）区分，两者不一样。
cholesterol 胆固醇，cholera—与胆囊有关的，相关词汇：cholecystitis 胆囊炎 cholangitis 胆管炎 choledochitis 胆总管炎 cholangiolitis 胆小管（毛细胆管）炎 cholecystolithiasis胆囊结石（病）
*延伸拓展：—itis 后缀一般表示xxx炎，如arthritis 关节炎，—sis 后缀，表示xxx的过程，状态等，如出现在疾病，则表示xxx病，翻译过程中，请注意不要遗漏。
His mother and two sisters, aged 36 and 38 years, are well. After his father’s infarct he had his lipids（脂质，血脂中的一种） measured; the cholesterol was 5.1mmol/L (desirable range 5.5mmol/L). He is a non-smoker who drinks 15 units of alcohol （详见系列1）per week.
Examination
His pulse rate is 75/min, blood pressure 124/78 mmHg. His temperature is 37.8°C. There is nothing abnormal to find in the cardiovascular and respiratory systems.
ANSWER 2
The previous chest pains lasting a second or two are unlikely to be of any real significance. Cardiac pain, and virtually any other significant pain, lasts longer than this, and stabbing momentary left-sided chest pains are quite common.
The positive family history （阳性家族病史）increases the risk of ischaemic heart disease（缺血性心脏病） but there are no other risk factors evident from the history and examination.
The relief from sitting up and leaning forward is typical of pain originating in the pericardium.
peri—前缀，表示xxx周围的，pericardium心包（膜）
The ECG shows elevation of the ST segment which is concave upwards, typical of pericarditis and unlike the upward convexity found in the ST elevation after myocardial infarction.
通常意义上，st段抬高可见于心梗，但也有其他情况
pericarditis，根据词根词源，可以得出，意思为心包炎（详情请看上下文解释）
The story of an upper respiratory tract infection shortly before suggests that this may well have a viral aetiology. The viruses commonly involved in pericarditis are Coxsackie B viruses（柯萨奇b组病毒）.
The absence of a pericardial rub does not rule out pericarditis. Rubs often vary in intensity and may not always be audible（可以听见的）. If this diagnosis was suspected, it is often worth listening again on a number of occasions for the rub.
Pericarditis often involves some adjacent myocardial inflammation and this could explain the rise in creatine kinase.
肌酸激酶，creatine 肌酸，creatinine 肌酐，CK是反应心肌梗塞的指标之一
Pericarditis may occur as a complication（并发症） of a myocardial infarction but this tends to occur a day or more later – either inflammation as a direct result of death of the underlying heart muscle, or as a later immunological effect (Dressler’s syndrome).
心肌梗塞后综合征：心肌梗死后数日至数周，可能会出现发热，心包炎，胸膜炎，肺炎的一种综合征，且可能反复发生。
Pericarditis also occurs as part of various connective tissue disorders, arteritides, tuberculosis and involvement from other local infections or tumours.
Myocardial infarction is not common at the age of 34 years but it certainly occurs. Other causes of chest pain, such as oesophageal pain or musculoskeletal pain, are not suggested by the history and investigations.
arteri-前缀，和动脉有关的，arterialtides动脉炎； tuberculosis 肺结核（病）；（o）esophageal 食管的；musculoskeletal 骨骼肌的
Thrombolysis in the presence of pericarditis carries a slight risk of bleeding into the pericardial space, which could produce cardiac tamponade.
thrombolysis溶栓（术），thrombo—血栓，lysis—溶解；cardiac tamponade 心包压塞
This arises when a fluid (an effusion（医学中多翻译为渗出或积液，如pleural ~胸腔积液）, blood or pus（脓）) in the pericardial space compresses the heart, producing a paradoxical pulse （奇脉/逆脉）with pressure dropping on inspiration, jugular venous pressure（颈静脉压） rising on inspiration and a falling blood pressure.
In this case, the evidence suggests pericarditis and thrombolysis is not indicated. The ECG and enzymes（酶） should be followed, the patient re-examined regularly for signs of tamponade, and analgesics given.
止疼药，镇痛剂
A subsequent rise in antibody titres （滴度）against Coxsackie virus suggested a viral pericarditis.
Symptoms and ECG changes resolved in 4–5 days. An echocardiogram did not suggest any pericardial fluid and showed good left ventricular muscle function. The symptoms settled with rest and non-steroidal anti-inflammatory drugs.
