B.43 DDX Chest Pain Syndromes

Question 1

B.43 DDX Chest Pain Syndromes

Most Important causes of chest pain

Answer 1

• Myocardial Infarction (MI)
• Pulmonary Embolism (PE)
• Aortic Dissection

Question 2

B.43 DDX Chest Pain Syndromes

Cardiopulmonary Causes of Chest Pain

Answer 2

• Angina Pectoris
• Acute Coronary Syndrome (ACS) – Unstable Angina & Myocardial Infarction (MI)
• Aortic Dissection
• Aneurysm
• Myocarditis
• Pericarditis
• Pulmonary Embolism (PE)
• Pneumonia
• Hemothorax
• Pneumothorax and Tension Pneumothorax
• Arrhythmia

Question 3

B.43 DDX Chest Pain Syndromes

GI causes of chest pain

Answer 3

• Gastroesophageal Reflux Disease (GERD)
• Hiatus Hernia
• Esophageal Disorders
• Cholecystitis

Question 4

B.43 DDX Chest Pain Syndromes

Problems with chest structure that would cause chest pain

Answer 4

• Spinal Nerve Problems
• Fibromyalgia
• Chest Wall Disorders
• Herpes Zoster
• Muscle Degenerative Diseases
• Myositis

Question 5

B.43 DDX Chest Pain Syndromes

Psychological Causes of Chest Pain

Answer 5

• Panic Attack
• Anxiety
• Clinical Depression
• Somatization Disorder
• Hypochondria

Question 6

B.43 DDX Chest Pain Syndromes

ACS

Answer 6

History and Risk Factors
- Smoking, HTN (Hypertension), High LDL, DM (Diabetes Mellitus)

Clinical Findings
Physical Examination:
- Pallor, cyanosis, dyspnea, orthopnea, periodic breathing, JVD (Jugular Venous Distension), hepatomegaly, anasarca

Symptoms:
- Pain, shortness of breath, sweating, dizziness, fear of death

Diagnosis:
- ECG, blood markers (troponin, CK-MB)
- Cardiac ischemia pain: heavy, pressing, radiating to neck, jaw, and arms

Question 7

B.43 DDX Chest Pain Syndromes

PE

Answer 7

Typical Presentation:
- Risk factors combined with pleural chest pain (stabbing type)

Clinical Findings:
Symptoms:
- Dyspnea, cough, hemoptysis, chest pain

Physical Examination:
- Tachypnea, tachycardia, signs of DVT (Deep Vein Thrombosis), fever, cyanosis

Diagnosis:
- ECG, SQI TnI, D-dimer, and ultrasound Doppler of the legs to check for DVT

Question 8

B.43 DDX Chest Pain Syndromes

Aortic Dissection

Answer 8

Physical Examination:
- Assess pulse, check for aortic murmur

-Diagnosis:
- Lab Tests: Biomarkers, D-dimer

ECG: To check for ischemia and coronary involvement

Monitoring: Heart rate (HR) and blood pressure (BP)

Imaging: Chest X-ray (CXR), Transthoracic echocardiogram (TTE), MRI, angiography

Question 9

B.43 DDX Chest Pain Syndromes

Analysis

Answer 9

History:
- Duration and nature of pain, family history, risk factors

• Physical Examination:
• Patient complaints

Imaging:
- Chest X-ray (CXR) or CT scan

• ECG:
• Look for troponin changes leading to catheterization lab referral
• V/Q Scan/CT Pulmonary Angiography:

Complete blood count
- Liver function tests and kidney function (creatinine)

• Cardiac enzymes and D-dimer