chest pain

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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)

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BUT after diagnostic evaluation only 15%-25% of patients with acute chest pain actually have ACS.

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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

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Acute MI, Same as angina but may be more severe,Sudden onset ,usually lasting >30min,often associated with dyspnea, weakness,nasuea,vomiting

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Pericarditis, Sharp,pleutic pain, aggrevated by change in position ,highly variable duration

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Aortic dissection, sudden onset in chest, usually occurs in setting of HTN, or underlying connective tissue disorder,

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Pulmonary embolism, Sudden onset of dyspnea and pain, usually pleuritic with pulmonary infarction, dyspnea, tachypnea, tachycardia, sign of right HF

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Pneumnia, Pleuritic pain, usually brief, over involved area, associated with dyspnea

Slide 12 :

Tracheobronchitis, Burning discomfort in midline, associated with coughing.

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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.

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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.

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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 :

Thank you

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	mahdiyehrQ6 11 Months ago.



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diagnosis of cardiac chest pain
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