TOPIC42: differential diagnosis of chest pain

Question 1

ACUTE chest pain (3 main causes)

Answer 1

1. MI
2. PE
3. AD

Question 2

cardiopulmonary causes of chest pain

Answer 2

CARDIO:

• angina pectoris
• ACS
• AD
• aneurysm
• myocarditis/ pericarditis
• arrhythmias

PULMO:

• PE
• pneumonia
• hemothorax
• pneumothorax

Question 3

other causes of chest pain

Answer 3

1. GI: GERD, hiatal hernia, esophageal disorders, cholecystitis
2. Chest structures: spinal nerve prob, fibromyalgia, chest wall pros, breast conditions, herpes zoster, muscle deg diseases, myositis
3. psychological: panic attack, anxiety, depression, somatization, hypochondria

Question 4

Chest pain syndrome: ACS

Answer 4

1. History and risk factors (HTN,DM, smoking, high LDL)
2. Physical: pallor, cyanosis, dyspnea, orthopnea, periodic breathing, full collar veins, hepatomegaly, anasarca
3. symptoms: Pain( heavy, pressing, radiates to neck,jaw and arms) shortness of breath, sweating, dizziness, fear of death
4. ECG
5. Blood markers

Question 5

Chest pain syndrome: PE

Answer 5

1. risk factors + pleural chest pain (stabbing pain)
2. physical: tachypnea, tachycardia, signs of DVT, fever, cyanosis)
3. symptoms: dyspnea, cough, hemoptysis, syncope
4. ECG: s1q3
5. US doppler for legs
6. CT pulm angio
7. V/P scintigram
8. D-dimer

Question 6

Chest pain syndrome: AD

Answer 6

1. history
2. physical: pulse, murmur
3. Biomarkers, D-dimer
4. ECG: Ischemia if coronaries involved
5. HR & BP monitor
6. painkiller response
7. CXR, TTE, MRI, angio
8. kidney function (creatinine)

Question 7

method to think

Answer 7

history + physical –> ECG (1st thing)

if you suspect smt life threatening:

• PE –> V/Q scan & lab, give anticoagulants
• AD–> avoid anticoagulants, CT/TEE , SURGERY
• ACS–> STEMI (PCI!!) / NSTEMI

NOT smt life threatening:

• pericarditis
• stable angina
• valve/ HCM
• Non cardiac