domingo, 29 de julho de 2012

Dor torácica


                As causas de dor torácica podem estar na própria parede do tórax, nas pleuras, nos pulmões, no coração, no pericárdio, nos vasos, no mediastino, no esôfago, no diafragma e em outros órgãos. A dor precordial ou retroesternal pode ter origem no coração ou na pleura, esôfago, aorta, mediastino, estômago e na própria parede torácica. A dor relacionada ao coração e à aorta compreende a dor da isquemia miocárdica, a dor pericárdica e a dor aórtica. Os brônquios intrapulmonares, o parênquima dos pulmões e as pleuras viscerais são insensíveis à dor.

A localização torácica de dois órgãos vitais - o coração e os pulmões - capazes de produzir dor é a razão de tanta preocupação com a dores torácicas. No coração se originam dores isquêmicas (a angina do peito e a dor do infarto) e nos pulmões se sediam doenças temidas: a [tuberculose] e o [câncer brônquico], que para o leigo enganosamente sempre produziriam dores torácicas.

A dor precordial de origem coronariana ou pericárdica se processa pela estimulação dos nervos (vasa-nervorum) justa-capilares na circulação coronariana com a inflamação química de corrente do transtorno metabólico das fibras cardíacas, ou por inflamação do pericárdio, e o comprometimento dos respectivos nervos que correspondem à C2, C3, C4, C5, C6, e à T2 até T6. As dores, não viscerais, do tegumento por fibrosite local, ou por irradiação das dores cérvico-braquiais ou de "peso" ou "mal-estar"ou "pontadas" precordiais, todas de extensão reduzida de uma ou duas polpas digitais, são dores superficiais, bem localizadas, e pioram com a compressão local ou com os movimentos da nuca, dos ombros, ou dos membros superiores. Tão freqüente quanto essas dores não viscerais são as dores em peso ou mal-estar precordial, geralmente acompanhadas de palpitações e que caracterizam, ao lado da ansiedade e da "crise de angústia", a sua origem exclusivamente psicógena.

A dor de origem isquêmica é devido à hipóxia celular. Toda vez que há desequilíbrio entre a oferta e o consumo de oxigênio, ocorre estimulação das terminações nervosas da adventícia das artérias e do próprio miocárdio por substâncias químicas liberadas durante a contração. A causa mais comum de isquemia miocárdica é a aterosclerose coronária e suas complicações, principalmente espasmo e trombose, assumindo características clínicas especiais na angina do peito e no [infarto do miocárdio]. Outra causa importante é a [estenose aórtica].

Julio Murilo Retzlaff
Acadêmico de Medicina (4° ano)

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