Chest pain pediatrics clerkship the university of chicago. Noncardiac causes are common, but it is important not to overlook serious conditions such as an acute coronary syndrome, pulmonary embolism, or pneumonia. The differential diagnosis of chest pain request pdf. Angina pectoris is the result of myocardial ischemia caused by an imbalance between myocardial blood supply and oxygen demand.
Thinking about the differential diagnosis of chest pain can be rewarding as a method of developing thought processes that can improve the prehospital providers skills. You can not treat all patients with chest pain the same due to the broad differential diagnosis that. Differential diagnosis of chest pain by dr farooq on 29 02. Ideally, the detailed history is taken where resuscitation facilities are available. Differential dx strategies university of massachusetts. In addition to a thorough history and physical examination, most patients should have a chest radiograph and an electrocardiogram. Differential diagnosis for the advanced practice nurse. Chest pain is pain or discomfort in the chest, typically the front of the chest. Chest pain is a common presenting complaint in many healthcare settings, including gi settings. In rosens emergency medicine concepts and clinical practice 8th ed. Oshea and others published differential diagnosis of chest pain find, read and cite all the research you need on. Differential diagnosis of chest pain request pdf researchgate. There are several lifethreatening causes of chest pain which need to be evaluated for first, which include. Chest pain differential diagnosis productive medic.
Diagnosing the cause of chest pain american family physician. Differential diagnosis of chest pain by dr farooq on 29 0230 h. Chest pain differential diagnosis free questions and answers for doctors and medical student exams. Dr ponka is an assistant professor and dr kirlew is a secondyear resident in the department of family medicine at the university of ottawa in ontario. Video must be watched to completion to be eligible for full credit. Differential diagnosis for chest pain oxford medical. In the uk, 1% to 2% of adults attend primary care each year with a new presentation of chest pain. Chest pain may be caused by many different problems. Acute chest or back pain and a pulse differential in the upper extremities 5. This uniquely organized onevolume text charts the way for early and accurate diagnosis of acute pain in specific regions of the body. At those times adding a different strategy often reveals more conditions.
Chest pain may be caused by either benign or lifethreatening etiologies and is usually divided into cardiac. Table 1 lists the differential diagnosis of chest pain. Chest pain differential diagnosis linkedin slideshare. Differential diagnosis of chest pain flashcards quizlet. Myocardial infarction, commonly known as a heart attack, is the irreversible necrosis of heart muscle secondary to prolonged ischemia. Other causes include muscle or bone problems, lung conditions or diseases, stomach. Pneumothorax sudden onset pleuritic chest pain may be sob if large risk factors e. It is the presenting complaint in 1% of officebased visits. Results of examination and hospital investigations, medical, family and social history, sex and age can be used to determine whether the pain is associated with a heart disease. Evaluation of chest pain differential diagnosis of.
Physical findings of arrythmias, murmurs, muffled heart tones and blood pressure. Outpatient diagnosis of acute chest pain in adults american. Clinical factors that increase likelihood of acsami. Certain strategies work better for different symptoms. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Feels like pressure, squeezing, burning, or strangling. Request pdf the differential diagnosis of chest pain chest pain is a frequent complaint of patients seeking urgent medical assistance. Differential diagnosis accesssurgery mcgrawhill medical. Emergency referral is required if acs is suspected and the patient currently has chest pain, or if they are currently pain free, but have had chest pain in the last 12 hours and a resting 12lead ecg is abnormal. Feels like tightness or heaviness, a band across the chest. D, is a practicing anesthesiologist at santa clara valley medical.
Referred pain referred pain can occur when the same nerves supplying areas of the chest wall also supply the tissues around the lungs, the diaphragm or the lining of the abdomen. No other single text provides such a userfriendly, methodical guide to differential diagnosis of acute pain. Furthermore, within the consideration of lifethreatening causes, patients may be suffering from coronary causes, as well as pulmonary embolism. A diagnosis of fibromyalgia may seem highly probable even from the referral letter, or after a few leading questions during the consultation.
Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the us per year. The main feature of myocardial ischemia impending infarction is usually prolonged chest pain. Diagnosis is both challenging and critical as clinical manifestations can be absent or rapidly fatal. However, when we speak of chest pain, the reason behind the same need not be something temporary. Cause grouping differentials classical history classic examination findings investigation findings initial test, diagnostic test. Get a printable copy pdf file of the complete article 1. This article throws light on some possible diagnosis. An expert algorithm to assist in the diagnosis of chest pain can be found here to go back to the main page on unstable angina, click here overview. Duration usually over 20 minutes pain is continuous, and its intensity does not alter. Noncardiac chest pain is the term that is used to describe pain in the chest that is not caused by heart disease or a heart attack.
Cardiac differential diagnosismilwems american heart association. Sections of the guide line were developed for use by patients and their. Chest pain that radiates to the back, jaw, left arm or left shoulder. Differential diagnosis is a process health care providers use to come to a definitive diagnosis, often by eliminating all other possible diseases and conditions. Chest pain of cardiac origin is suggested by pain that increases with physical exertion, history of palpitations, and an ill appearance. Chest pain cardiac or not treat patient as though he is critical until proved otherwise history risk factors, ho ihd, previous rxs, previous chest pain pain heart burn burning. Making a differential diagnosis of chest pain is very extensive because so many different factors can cause this. Chest pain is something that cannot be neglected under any circumstances whatsoever. It may be caused by a variety of cardiac and noncardiac abnormalities. Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Differential diagnosis chest pain questions flashcards. Common and important causes of chest pain for doctors.
Associated symptoms may include pain in the shoulder, arm, upper abdomen or jaw or nausea, sweating or shortness of breath. The differential diagnosis of chest pain syndrome is broad and disparate, including disease processes that range from nonurgent to life threatening. The differential diagnosis of chest pain sciencedirect. It is exacerbated by deep breathing, coughing, sneezing, or. This usually results from an imbalance in oxygen supply and demand, which is most often caused by plaque rupture with thrombus formation in a coronary vessel, resulting in an acute reduction of blood supply to. It is a serious concern for patients and practitioners. Angina pectoris differential diagnoses medscape reference.
The differential diagnosis is broad and includes cardiac e. Differential diagnosis for chest pain oxford medical education. The lack of a goldstandard for the diagnosis of this clinical entity has led to a preference for describing associated abnormalities if present 3,4, including cardiac dysfunction identified. Nontraumatic chest pain is one of the most common causes of emergency department visits and is common in both inpatients and outpatients. This refers to chest pain that is not sharp and is not the patients familiar angina. Idiopathic chest pain spinal cord compression tumor. It may be described as sharp, dull, pressure, heaviness or squeezing. Explain the value of a cardiovascular history, the value and limitations of ecg, troponin, and other point of care diagnostics relate how to develop a. Differential diagnosis of acute chest pain oscestop. In most people, noncardiac chest pain is related to a problem with the esophagus, such as gastroesophageal reflux disease. Your doctor might treat chest pain with medication, noninvasive procedures, surgery, or a combination of these methods. Pain due to insufficient blood flow to the heart is also.
Marfans appearance, copdasthma ipsilateral reduced chest expansion. Evaluate wells score see below obtain ddimer high levels may be diagnostic of pe ultrasound, ct, pulmonary angiogram, mri wells criteria for pulmonary embolism clinical feature points clinical ss of dvt minimum of leg swelling and pain with palpitation of deep veins 3 an alternative diagnosis is less likely than pe 3. After generating a differential, you may decide that you would like to expand upon it. Chest pain david ponka, md and michael kirlew, md dr ponka is an assistant professor and dr kirlew is a secondyear resident in the department of family medicine at the university of ottawa in ontario. Evaluation of patients with chest pain evaluation of patients with. It is the presenting complaint in 1% of clinicbased visits. Differential diagnosis of chest pain pain is a common health condition, and is usually temporary in nature. Chest pain knowledge for medical students and physicians. Assessment of chest pain differential diagnosis of.
Nurses can play a critical role in the differential diagnosis of chest pain by obtaining a thorough. Start studying differential diagnosis of chest pain. A family history of cardiac disease or sudden unexplained death are significant. Treatment depends on the cause and severity of your chest pain. Select a symptom or disease and get instant differential diagnosis information. Common and important causes of chest pain for doctors and medical students. A herniated disc or arthritis in the neck can cause bandlike chest pain. Chest pain may arise as a result of problems with any of the structures located between the neck and the upper part of the abdomen the following is a list of tissues and organs that when disease is present may result in chest pain.
Thinking through the differential diagnosis boerhaave syndrome is a transmural perforation of the esophagus to be distinguished from malloryweiss syndrome, a nontransmural esophageal tear also associated with vomiting. However, the lack of specificity of the many symptoms associated with widespread pain means that other diagnoses have to be considered. The article focuses on the factors to consider in the differential diagnosis of chest pain. Pdf top 10 differential diagnoses in family medicine. The higher the lr is above 1, the better it rules in disease greater than 10 is considered good. The initial goal in patients presenting with chest pain is to determine if the patient needs to be referred for further testing to rule in or out acute. Angina is a common presenting symptom typically, chest pain among patients with coronary artery disease. It can be divided into heartrelated and nonheartrelated pain. The differential diagnosis of generalized pain sciencedirect. A differential diagnosis of acute chest pain drbeen. Assessment of chest pain differentials bmj best practice.
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