Differential diagnosis in patientswith chest painCardiac              (MI, Angina pectoris, Pericarditis, AD)Pulmonary cau...
Musculoskeletal     (costochondritis, strain)Gastrointestinal   (GERD,E.spasm)Nonspecific chest pain
PROPER HISTORY EXAMINATION
GENERAL EXAMINATIONGENERAL APPEARANCE APPEARANCE- DISTRESSED/LEVINE SIGNBUILT AND NOURISHMENTPALLOR:EXACERBATE ANGINA/H...
ICTERUSCYANOSISCLUBBINGOEDEMA- limb swelling( DVT-Pulmonary embolism)
LYMPHADENOPATHYEXAMINE ALL LYMPH NODES
ARTERIAL PULSERATERHYTHMCHARACTER-pulses paradoxes(constrictive pericarditis)VOLUMEVESSEL WALL CONDITION-thickening- ...
BLOOD PRESSUREHypotensioncan occur in√ MI√Pericardialtemponade√PleuralEffusion√GI bleedingBP both arms not equalAORTICDIS...
RESPIRATORY RATE14-16/min
JUGULAR VENOUS PULSE
ELEVATED√ RIGHT VENTRICULAR INFARCTION√ PULMONARY EMBOLISM√CONSTRICTIVE PERICARDITIS
TEMPERATUREPYREXIA:FIRST 3 DAY AFTER MIFever suggest infectious cause
HEAD –FOOT EXAMINATIONXanthoma and xanthelasma Arcus senilisDeformity
INSPECTIONPALPATIONPERCUSSIONAUSCULTATION
INSPECTIONSKIN-rash of shinglesSigns of trauma /swellingCVS-Any visible pulsations,JVPRESPIRATORY-Movements of chest w...
PALPATIONLocalised tendernessHyperesthesia-Herpes ZosterCrepitus-rib fractureCVS-Apex beat,Thrills,Palpable s3/s4 ,any...
RESPIRATORY-position of trachea, respiratory movements(Pneumothorax ),Vocal fremitus,Chest expansion
PERCUSSIONPneumothoraxhyper resonantPneumoniadull
AUSCULTATIONCVSS1/S2S3/S4(MI-Audible s4)Murmurs(AD)RESPIRATORYBreath sounds,vocal fremitus,pleural rub,crackles
EXAMINATION FINDINDS
MYOCARDIAL INFARCTIONSIGNSSIGNS OF SYMPATHETIC ACTIVATION     PALLOR     SWEATING     TACHYCARDIASIGNS OF VAGAL STIMULATIO...
MIAbnormal vital signs (tachycardia, bradycardia, tachypnea, hypotension)Signs of hypoperfusion (eg confusion, ashen co...
Clinical:HTNBP both arms not equaldistal pulses diminishedMurmurcardiac tamponade Paraplegia.
RESPIRATORY CAUSEPLEURAL EFFUSION√dull on percussion√ bronchial breathing sound√ pleural rub√ crackle
PULMONARY EMBOLISMPhysical ExaminationTachycardia, tachypneaIf severe, can get hypotension, syncope, and RV failure (↑JVP)
PNEUMOTHORAXDecreased expansion of chest decreased breath soundsdecreased tactile/vocal fremitus on side of pneumothora...
MUSCULOSKELETAL CHEST PAINLOCAL TENDERNESSENHANCED BY EMOTION,COUGHING,SNEEZING
SKIN HERPES ZOSTERRashFeveritcy skinburning sensationstabbing paintingling
GIT CAUSESRelief  antacid.
THANK U
Clinical examination chest pain
Clinical examination chest pain
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Clinical examination chest pain

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clinical approach to a patient with chest pain

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Clinical examination chest pain

  1. 1. Differential diagnosis in patientswith chest painCardiac (MI, Angina pectoris, Pericarditis, AD)Pulmonary causes (PE, Pneumothorax, pneumonia)Psychosocial anxiety
  2. 2. Musculoskeletal (costochondritis, strain)Gastrointestinal (GERD,E.spasm)Nonspecific chest pain
  3. 3. PROPER HISTORY EXAMINATION
  4. 4. GENERAL EXAMINATIONGENERAL APPEARANCE APPEARANCE- DISTRESSED/LEVINE SIGNBUILT AND NOURISHMENTPALLOR:EXACERBATE ANGINA/HEART FAILURE
  5. 5. ICTERUSCYANOSISCLUBBINGOEDEMA- limb swelling( DVT-Pulmonary embolism)
  6. 6. LYMPHADENOPATHYEXAMINE ALL LYMPH NODES
  7. 7. ARTERIAL PULSERATERHYTHMCHARACTER-pulses paradoxes(constrictive pericarditis)VOLUMEVESSEL WALL CONDITION-thickening- atherosclerosisOTHERPERIPHERAL PULSATIONS
  8. 8. BLOOD PRESSUREHypotensioncan occur in√ MI√Pericardialtemponade√PleuralEffusion√GI bleedingBP both arms not equalAORTICDISSECTION
  9. 9. RESPIRATORY RATE14-16/min
  10. 10. JUGULAR VENOUS PULSE
  11. 11. ELEVATED√ RIGHT VENTRICULAR INFARCTION√ PULMONARY EMBOLISM√CONSTRICTIVE PERICARDITIS
  12. 12. TEMPERATUREPYREXIA:FIRST 3 DAY AFTER MIFever suggest infectious cause
  13. 13. HEAD –FOOT EXAMINATIONXanthoma and xanthelasma Arcus senilisDeformity
  14. 14. INSPECTIONPALPATIONPERCUSSIONAUSCULTATION
  15. 15. INSPECTIONSKIN-rash of shinglesSigns of trauma /swellingCVS-Any visible pulsations,JVPRESPIRATORY-Movements of chest wall,position of trachea(*deviation away from side affected- Pneumothorax)
  16. 16. PALPATIONLocalised tendernessHyperesthesia-Herpes ZosterCrepitus-rib fractureCVS-Apex beat,Thrills,Palpable s3/s4 ,any other palpable events
  17. 17. RESPIRATORY-position of trachea, respiratory movements(Pneumothorax ),Vocal fremitus,Chest expansion
  18. 18. PERCUSSIONPneumothoraxhyper resonantPneumoniadull
  19. 19. AUSCULTATIONCVSS1/S2S3/S4(MI-Audible s4)Murmurs(AD)RESPIRATORYBreath sounds,vocal fremitus,pleural rub,crackles
  20. 20. EXAMINATION FINDINDS
  21. 21. MYOCARDIAL INFARCTIONSIGNSSIGNS OF SYMPATHETIC ACTIVATION PALLOR SWEATING TACHYCARDIASIGNS OF VAGAL STIMULATION VOMITING BRADYCARDIA
  22. 22. MIAbnormal vital signs (tachycardia, bradycardia, tachypnea, hypotension)Signs of hypoperfusion (eg confusion, ashen color)Shortness of breathAsymmetric breath sounds or pulses heart murmursPulsus paradoxus > 10 mm Hg
  23. 23. Clinical:HTNBP both arms not equaldistal pulses diminishedMurmurcardiac tamponade Paraplegia.
  24. 24. RESPIRATORY CAUSEPLEURAL EFFUSION√dull on percussion√ bronchial breathing sound√ pleural rub√ crackle
  25. 25. PULMONARY EMBOLISMPhysical ExaminationTachycardia, tachypneaIf severe, can get hypotension, syncope, and RV failure (↑JVP)
  26. 26. PNEUMOTHORAXDecreased expansion of chest decreased breath soundsdecreased tactile/vocal fremitus on side of pneumothoraxHyperresonant percussion noteIn tension pneumothorax tracheal deviation away from the side of the pneumothorax
  27. 27. MUSCULOSKELETAL CHEST PAINLOCAL TENDERNESSENHANCED BY EMOTION,COUGHING,SNEEZING
  28. 28. SKIN HERPES ZOSTERRashFeveritcy skinburning sensationstabbing paintingling
  29. 29. GIT CAUSESRelief  antacid.
  30. 30. THANK U
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