17. Douleur thoracique Flashcards
dlr thoracique systèmes
- cardio incluant vaisseaux (dissection)
- resp
- GI + oesophage
- Paroi thoracique
- Psy
ddx cardio
Cardiac
- Acute Coronary Syndrome (ACS): Angine stable, instable, NSTEMI type 1 ou 2, Infarctus STEMI
- Myocarditis
- Pericarditis
- dissection Ao
- arrhythmia
Pericarditis sx
Typical chest pain:
sharp and pleuritic, improved by sitting up and leaning forward
Myocarditis treatment
NSAIDs = CONTRE INDIQUÉS!
Pas de ROH
Limiter exercice
mngmt depending on cause (esoninophilic, giant cell, sarcoidose…)
Pericarditis ECG changes
widespread ST-segment elevation
Pericardite avec augmentation des tropos % et dx
30%
myopericarditis or perimyocarditis
Pericarditis hospitalisation criteria
Fever (>38°C [100.4°F]).
●Subacute course over days to weeks (without acute onset of chest pain).
●Evidence suggesting cardiac tamponade (eg, hemodynamic compromise).
●A moderate to large pericardial effusion (ie, an end-diastolic echo-free space of more than 20 mm).
●Immunosuppressed patients.
●Therapy with warfarin or non-vitamin K oral anticoagulants.
●Acute trauma.
●Failure to show clinical improvement following seven days of appropriately dosed nonsteroidal antiinflammatory drug and colchicine therapy.
●Elevated cardiac troponin, which suggests myopericarditis/perimyocarditis.
Pericarditis tx
NSAIDs
in combination with colchicine
ad resolution of sx - taper down tx
and normalization of CRP
Ddx pulmonaire dlr thoracique
Pulmonary Embolism
Tension pneumothorax (see trauma)
Pneumonia
COPDE
Acute chest syndrome (sickle cell)
Dissection Ao sx, RXP difference BP
- Sudden, severe pain radiating to back
- Widened mediastinum on CXR,
- > 20mmHg difference in BP on left vs. right
Boerhaave’s sydrome tx
(esophageal rupture)
Treatment
NPO
IV Abx, IV PPI, Endoscopy/surgical repair
dlr thoracique - chest wall
Costochondritis
MSK
Herpes Zoster
herpes zoster 1) R/O (2)
- R/O eye, ear, or central nervous system involvement
- immunosuppression?
herpes zoster tx (2) acute
Si pas de complications, onset <72h
* view uptodate algo
Antiretroviral
valacyclovir 1g PO TID
Acute neuritis (pain)
NSAIDs + acet
Postherpetic neuralgia definition and tx
pain present after 90 days (3 mo)
gabapentin
