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Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
Chest pain approach
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Chest pain approach

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dr jayanta paul

dr jayanta paul

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  • This lecture is good, thanks for your sharing. At my college, no one tell me about how to approach to the chest pain, we just study and study what is read in the books which have no way to aproach to anything. Hope to see more and more lecture from you, the next part i want to approach is dyspnea which me so confused. Hope again to see your feedback. Thanks in advance
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  • 1. APPROACH TO A PATIENT WITH CHEST PAIN
    DR JAYANTA PAUL
    1ST YEAR PGT, DEPT OF MEDICINE
    BURDWAN MEDICAL COLLEGE
  • 2.
    • 5 Million emergency department visits
    • 3. 2 million hospitalizations annually with cost of more than $8 billion
    • 4. Cardiac etiology found in less than one third
    • 5. 2% of patients with acute MI are unrecognized and discharged from the ED
  • Goals
    Rapid recognition and management of true ACS
    Recognition of other life-threatening causes of chest pain
    Minimize cost and hospitalization in patients with chest pain of benign etiology.
  • 6. PAIN IN THE CHEST BUT ORIGIN??
    HEART
    LUNGS
    OESOPHAGUS
    MUSCULOSKELETAL STRUCTURES OF THORAX NECK,OR SHOULDER
    ABDOMEN
    ANXIETY MANIFESTATION
  • 7. ISCHEMIC CARDIAC PAIN
    V/S
    NON-CARDIAC PAIN
  • 8. Cardiac causes of chest pain
    1.
    angina
    2.
    AMI
    3.
    pericarditis
  • 9. case1
    Cardiac cause
    A 50 years old patient presented with retro sternal chest pain which radiates to the left arm, jaw, neck
    1.Exacerbation with ?
    2.Relived with ?
    3.Fever ?
    4.Type of chest pain ?
    5.Precipitating factors ?
    6. male/ female ?
    Auscultatory finding
    Clinical diagnosis ?
    investigation
  • 10. Clinical Spectrum of Acute Coronary Syndromes
    Stable angina
    Unstable
    angina
    Non-STE MI
    STE MI
    Evidence of necrosis
    None
    Positive
    Positive
    ST-segment
    elevation
    ST-segment depression
    and/or
    T-wave inversion
    ST-segment depression
    and/or
    T-wave inversion
    ECG early
    ECG late
    No Q
    No Q
    Q develops
  • 11. Respiratory causes of chest pain
    1.
    Pulmonary embolism
    Tension pneumothorax
    2.
    3.
    pneumonia
  • 12. Case 2
    Respiratory cause
    A 30 years old patient presented with sudden onset right sided chest pain not radiates to the any other sites
    Predisposing factors ?
    Fever ?
    types of chest pain ?
    Other associated symptoms ?
    Auscultatory findings
    Breath sounds
    Clinical diagnosis ?
    investigation
  • 13. PULMONARY EMBOLISM
    • RISK FACTORS FOR THROMBOEMBOLISM
    • 14. CLINICAL FEATURES DEPEND ON SIZE
    • 15. FAINTNESS OR COLLAPSE
    • 16. CENTRAL CHEST PAIN
    • 17. APPREHENSION
    • 18. SEVERE DYSPNOEA
    • 19. PLEURITIC PAIN
    • 20. HAEMOPTYSIS
  • TENSION PNEUMOTHORAXDIAGNOSIS
  • 21. Vascular causes of chest pain
    1.
    Thoracic aortic dissection
    2.
    Sickle cell anemia
  • 22. case3
    Vascular cause
    A 33 years old woman during her pregnancy presented with severe sudden onset severe chest pain which radiates to the back between the shoulder baldes
    Character of pain : tearing or ripping sensation
    Precipitating factors:
    Hypertension
    Connective tissue disorder
    Diagnosis ?
  • 23. AORTIC DISSECTIONPREDISPOSING FACTORS
    • HTN
    • 24. AORTIC ATHEROSCLEROSIS
    • 25. NON-SPECIFIC AORTIC ANEURYSM
    • 26. AORTIC COARCTATION
    • 27. COLLAGEN DISORDERS MARFANS SYND,,,E D SYNDROME
    • 28. FIBROMUSCULAR DYSPLASIA
    • 29. PREVIOUS AORTIC SURGERY CABG AV REPLACEMENT
    • 30. PREGNANCY(3RD, TRIMESTER)
    • 31. TRAUMA
    • 32. IATROGENIC
  • AORTIC DISSECTIONCLINICAL FEATURES
  • GI causes of chest pain
    1.
    Esophageal reflexes
    2.
    Esophageal rupture
    3.
    pancreatitis
    4,
    Peptic ulcer
  • 44. case4
    Gastrointestinal cause
    A 30 years old patient presented with retro sternal & epigastric burning sensation not radiates to any other sites.
    Pain most often exacerbated by
    alcohol, aspirin & foods
    Lying down , morning
    Pain is often relieved by
    antacids
    Clinical diagnosis ?
    Investigation ?
  • 45. Musculoskeletal causes of chest pain
    1.
    costochondritis
    2.
    trauma
  • 46. case5
    Musculoskeletal cause
    A 38 years old patient presented with chest pain for last 20 days , worsened with
    Active and passive movement
    On examination : local tenderness
    swelling , redness
    present
    +/-
    Clinical diagnosis ?
    investigation
  • 47. Others
    HERPES ZOSTER
    psychological
  • 48. Thank you

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