Cardiac Differential Diagnosis

Question 1

Cardiac

Myocardial ischemia (angina)

Answer 1

• retrosternal radiating tightness
• last a few minute (< 10m)
• brought on by stress or exertion
• relieved with rest or nitroglycerin
• ST segment elevation or depression
• flat or inverted T wave

Question 2

Cadiac

Pericarditis

Answer 2

• sharp
• pleuritic pain that caries with position or inspiration
• friction rub on auscultation
• lasts for hours to days

Question 3

GI

GERD

Answer 3

• retrosternal burning
• precipitated by certain foods
• worse in supine
• exertion has no effect
• relieved by antacids
• nitroglycerin no effect

Question 4

GI

Peptic ulcer

Answer 4

• epigastric burning
• occurs after meals
• exertion no effect
• relieved by antacids not nitroglycerin

Question 5

GI

Esophageal spasm

Answer 5

• retrosternal pain accompanied by dysphagia
• precipitated by meals
• exertion no effect
• may be relieved by nitroglycerin

Question 6

GI

Biliary collic/gallblader

Answer 6

• deep brain pain in upper right quadrant
• may radiate to middle of back or right shoulder
• occurs after fatty food consumption or alcohol use
• exertion has no effect
• not relieved by antacids or nitro

Question 7

Musculoskeletal

Costochondral syndrome

Answer 7

• sternal pain worsened by chest movement
• costochondral junctions tender to palpation
• relieved by anti-inflammatories not nitroglycerin

Question 8

Musculoskeletal

Cervical radiculitis

Answer 8

• constant ache or shooting pain in shoulder
• often in myo/dermatomal pattern
• neck movements make it worse

Question 9

Cardiac

Acute Coronary Syndrome

Answer 9

• radiating retrosternal pressure
• more severe and last longer than angina
• EKG: ST segment elevation or depression

Question 10

Cardiac

Aortic dissection

Answer 10

• Tearing or ripping pain that migrates over time to the chest and back
• bad abdominal pain
• dyspnea
• possible asymmetry of BP
• widened mediastinum on chest x-ray
• may mimic stroke

Question 11

Pulmonary

Pulmonary embolism

Answer 11

• localised pleurtic pain, dyspnea
• pleural friction rub
• predisposing conditions or risk factors for DVT

Question 12

Pulmonary

Pneumonia

Answer 12

• pleuritic chest pain
• productive cough
• abdnormal lung auscultation and percussion (consolidation)
• chest x-ray shows infiltrate

Question 13

Pulmonary

Esophageal spasm

Answer 13

• retrosternal pain worse with swallowing
• hx of dysphagia

Question 14

Pumonary

Acute cholecystitis

Answer 14

• right upper quadrant or epigastric pain
• nausea and vomiting
• fatty food intolerance or recent fatty meal