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Slide 1 :
Approach to the patient with Chest pain DR,M,khabazian
Slide 2 :
Acute chest pain is one of the most common reasons for presentation to the emergency department(ED)
Slide 3 :
BUT after diagnostic evaluation only 15%-25% of patients with acute chest pain actually have ACS.
Slide 4 :
Cause of acute chest pain
Slide 5 :
1-Angina,Retrosternal chest pressure,burning ,heaviness,radiating occasionally to neck,jaw,epigastrium,shoulders,left arm,,,And precipitated bye exercise, cold weather,emotional stress,And duration is 2-10 min
Slide 6 :
Unstable angina, Same as angina but may be more severe,typically<20min,lower tolerance for exertion,crecendo pattern
Slide 7 :
Acute MI, Same as angina but may be more severe,Sudden onset ,usually lasting >30min,often associated with dyspnea, weakness,nasuea,vomiting
Slide 8 :
Pericarditis, Sharp,pleutic pain, aggrevated by change in position ,highly variable duration
Slide 9 :
Aortic dissection, sudden onset in chest, usually occurs in setting of HTN, or underlying connective tissue disorder,
Slide 10 :
Pulmonary embolism, Sudden onset of dyspnea and pain, usually pleuritic with pulmonary infarction, dyspnea, tachypnea, tachycardia, sign of right HF
Slide 11 :
Pneumnia, Pleuritic pain, usually brief, over involved area, associated with dyspnea
Slide 12 :
Tracheobronchitis, Burning discomfort in midline, associated with coughing.
Slide 13 :
Spontaneeous pneumothorax, Sudden onset of unilateral pleuritic pain, with dyspnea,
Slide 14 :
Esophageal reflux, Burning substernal and epigastric discomfort, 10-60 min in duration, Aggrevated by large meal and postparandial recumbency, relieved by antiacid,
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Peptic ulser, prolonged epigastric or substernal burning , relieved by antiacid or food.
Slide 16 :
Gallbldder disease, prolonged epigastric or right upper quadrant pain, Un provoked or following meal
Slide 17 :
Pancreatitis, prolonged , intense epigastric and substernal pain, Risk factor including alcohol , hyprt TG , medication.
Slide 18 :
Other cause,, Costochondritis, Cervical disc disease, Trauma, Herpes zoster. Panic disorder,
Slide 19 :
Algorythm for the initial diagnostic approach to a patient with chest pain
Slide 20 :
1,Assess vital sign: a,unstable,,, Stablize. Assess for STMI,Massive PE,Aortic dissection,Pericardial tamponade
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B,stable,,,, 2-ECG & CXR ECG diagnostic, a,yes,STMI,Pericarditis (elevetion of ST),ST depression or inverted T-?biomarker check?NSTMI or USA
Slide 22 :
b,NO,? CXR diagnostic a,yes?pnemothorax,aortic dissection,pneumonia b,NO?
Slide 23 :
Assess risk of ACS and check cardiac markers of necrosis? NSTMI Possible UA Alternative diagnosis
Slide 24 :
Assess risk of pulmonary emboli? If low?check D-dimer?positive;Imaging negative;alternative diagnosis If high?Imaging?positive;PE negative;alternative diagnosis
Slide 25 :
Assess risk of aortic dissection If low?alternative diagnosis If high?Imaging?positive;aortic dissection negative;alternative diagnosis
Slide 26 :
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diagnosis of cardiac chest pain
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