CHEST PAIN Flashcards
chest pain key hx: character
quality and RADIATION
chest pain key hx: timing/triggers
context (exertional, postprandial, positional, cocaine use, trauma)
chest pain key hx: assoc sxs
sweating nausea dyspnea palpitations sense of doom fever HX OF SIMILAR SXS
chest pain key hx: exac/allev factors
esp medications
chest pain key hx: medhx
heart or lung dz
hx of diagnostic testing
cardiac RFs (HTN, HLD, smoking, famhx early MI)
PE RFs (hx of DVT, coagulopathy, malignancy, recent immobilization, pregnancy)
chest pain key PE
VS +/- BP both arms
complete CV exam (incl JVD, PMI, chest wall tenderness to palpation, heart sounds, pulses, edema)
lung and abd exams
lower extremity edema (inspection for signs of DVT)
myocardial infarction ddx
GERD angina costochondritis aortic dissection pericarditis PE pneumothorax
myocardial infarction w/u
ECG CPK-MB, troponins x3 CXR CBC elytes helical CT echocardiography cardiac catheterization d-dimer
acute chest syndrome ddx
PE pna MI pneumothorax aortic dissection
acute chest syndrome w/u
CBC with retic count and periph smear LDH ABG d-dimer CXR CPK-MB, trop ECG CTA chest with contrast
GERD ddx
esophagitis peptic ulcer dz esophageal spasm MI angina
GERD w/u
ECG barium swallow upper endoscopy esophageal pH monitoring H pylori stool Ag
stable angina ddx
esophageal spasm
esophagitis
stable angina w/u
ECG CPK-MB, trop CXR CBC elytes exercise stress test upper endoscopy/pH monitor cardiac catheterization
pericarditis ddx
aortic dissection MI costochondritis GERD esophageal rupture
pericarditis w/u
ECG CPK-MB, trop CXR echocardiography CBC upper endoscopy ESR
costochondritis ddx
pna MI PE pericarditis pleurisy muscle strain
costochondritis w/u
ECG
CXR
CPK-MB, trop
CBC
PE ddx
pna costochondritis MI CHF aortic dissection
PE w/u
D-dimer CTA chest with contrast CXR ECG ABG CPK-MB, trop CBC elytes, BUN/Cr, glucose doppler u/s legs
aortic dissection ddx
MI pericarditis esophageal rupture esophageal spasm GERD pancreatitis fat embolism
aortic dissection w/u
TTE ECG CPK-MB, trop CXR CBC amylase, lipase CTA chest with contrast MRI/MRA aorta aortic angiography upper endoscopy
