Chest pain approach

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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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Chest pain approach

  1. 1. APPROACH TO A PATIENT WITH CHEST PAIN<br />DR JAYANTA PAUL<br />1ST YEAR PGT, DEPT OF MEDICINE<br />BURDWAN MEDICAL COLLEGE<br />
  2. 2. <ul><li>5 Million emergency department visits
  3. 3. 2 million hospitalizations annually with cost of more than $8 billion
  4. 4. Cardiac etiology found in less than one third
  5. 5. 2% of patients with acute MI are unrecognized and discharged from the ED</li></li></ul><li>Goals<br />Rapid recognition and management of true ACS<br />Recognition of other life-threatening causes of chest pain<br />Minimize cost and hospitalization in patients with chest pain of benign etiology.<br />
  6. 6. PAIN IN THE CHEST BUT ORIGIN??<br />HEART<br />LUNGS<br />OESOPHAGUS<br />MUSCULOSKELETAL STRUCTURES OF THORAX NECK,OR SHOULDER<br />ABDOMEN<br />ANXIETY MANIFESTATION<br />
  7. 7. ISCHEMIC CARDIAC PAIN<br />V/S<br />NON-CARDIAC PAIN<br />
  8. 8. Cardiac causes of chest pain<br />1.<br />angina<br />2.<br />AMI<br />3.<br />pericarditis<br />
  9. 9. case1<br />Cardiac cause<br />A 50 years old patient presented with retro sternal chest pain which radiates to the left arm, jaw, neck<br />1.Exacerbation with ?<br />2.Relived with ? <br />3.Fever ?<br />4.Type of chest pain ? <br />5.Precipitating factors ?<br />6. male/ female ? <br />Auscultatory finding <br />Clinical diagnosis ?<br />investigation<br />
  10. 10. Clinical Spectrum of Acute Coronary Syndromes<br />Stable angina<br />Unstable<br />angina<br />Non-STE MI<br />STE MI<br />Evidence of necrosis<br />None<br />Positive<br />Positive<br />ST-segment <br />elevation<br />ST-segment depression<br />and/or<br />T-wave inversion<br />ST-segment depression<br />and/or<br /> T-wave inversion<br />ECG early<br />ECG late<br />No Q<br />No Q<br />Q develops<br />
  11. 11. Respiratory causes of chest pain<br />1.<br />Pulmonary embolism<br />Tension pneumothorax<br />2.<br />3.<br />pneumonia<br />
  12. 12. Case 2<br />Respiratory cause<br />A 30 years old patient presented with sudden onset right sided chest pain not radiates to the any other sites <br />Predisposing factors ?<br />Fever ?<br /> types of chest pain ?<br />Other associated symptoms ? <br />Auscultatory findings<br />Breath sounds<br />Clinical diagnosis ?<br />investigation<br />
  13. 13. PULMONARY EMBOLISM<br /><ul><li>RISK FACTORS FOR THROMBOEMBOLISM
  14. 14. CLINICAL FEATURES DEPEND ON SIZE
  15. 15. FAINTNESS OR COLLAPSE
  16. 16. CENTRAL CHEST PAIN
  17. 17. APPREHENSION
  18. 18. SEVERE DYSPNOEA
  19. 19. PLEURITIC PAIN
  20. 20. HAEMOPTYSIS</li></li></ul><li>TENSION PNEUMOTHORAXDIAGNOSIS<br />
  21. 21. Vascular causes of chest pain<br />1.<br />Thoracic aortic dissection <br />2.<br />Sickle cell anemia<br />
  22. 22. case3<br />Vascular cause<br />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<br />Character of pain : tearing or ripping sensation<br />Precipitating factors: <br />Hypertension <br />Connective tissue disorder<br />Diagnosis ?<br />
  23. 23. AORTIC DISSECTIONPREDISPOSING FACTORS<br /><ul><li>HTN
  24. 24. AORTIC ATHEROSCLEROSIS
  25. 25. NON-SPECIFIC AORTIC ANEURYSM
  26. 26. AORTIC COARCTATION
  27. 27. COLLAGEN DISORDERS MARFANS SYND,,,E D SYNDROME
  28. 28. FIBROMUSCULAR DYSPLASIA
  29. 29. PREVIOUS AORTIC SURGERY CABG AV REPLACEMENT
  30. 30. PREGNANCY(3RD, TRIMESTER)
  31. 31. TRAUMA
  32. 32. IATROGENIC</li></li></ul><li>AORTIC DISSECTIONCLINICAL FEATURES<br /><ul><li>TEARING PAIN
  33. 33. ABRUPT ONST
  34. 34. COLLAPSE
  35. 35. MARFAN`S SYNDROME
  36. 36. PT APPEARS TO BE IN SHOCK
  37. 37. BP---NORMAL OR reduced
  38. 38. ASYMMETRY OF PULSES
  39. 39. MI
  40. 40. PARAPLEGIA(SPINAL)
  41. 41. ACUTE ABDOMEN(MESENTERIC CAELIAC)
  42. 42. RENAL FAILURE
  43. 43. ACUTE LIMB ISCHEMIA(LEGS)</li></li></ul><li>GI causes of chest pain<br />1.<br />Esophageal reflexes <br />2.<br />Esophageal rupture<br />3.<br />pancreatitis<br />4,<br />Peptic ulcer<br />
  44. 44. case4<br />Gastrointestinal cause<br />A 30 years old patient presented with retro sternal & epigastric burning sensation not radiates to any other sites. <br />Pain most often exacerbated by<br />alcohol, aspirin & foods <br />Lying down , morning <br />Pain is often relieved by <br />antacids<br />Clinical diagnosis ?<br />Investigation ?<br />
  45. 45. Musculoskeletal causes of chest pain<br />1.<br />costochondritis<br />2.<br />trauma<br />
  46. 46. case5<br />Musculoskeletal cause <br />A 38 years old patient presented with chest pain for last 20 days , worsened with<br />Active and passive movement<br />On examination : local tenderness<br /> swelling , redness<br />present<br />+/-<br />Clinical diagnosis ?<br />investigation<br />
  47. 47. Others <br />HERPES ZOSTER <br />psychological<br />
  48. 48. Thank you<br />

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