1. Chest pain is a common complaint that can be caused by cardiac, respiratory, gastrointestinal, vascular, musculoskeletal and other issues. A thorough history and physical exam is needed to determine the underlying cause. 2. A careful differential diagnosis should be established to identify life-threatening issues like acute coronary syndrome, pulmonary embolism, or aortic dissection versus more benign conditions. 3. Appropriate tests and investigations should then be ordered based on the leading clinical diagnosis to identify the cause of chest pain and guide management.

1. APPROACH TO A PATIENT WITH CHEST PAINDR JAYANTA PAUL1ST YEAR PGT, DEPT OF MEDICINEBURDWAN 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 EDGoalsRapid recognition and management of true ACSRecognition of other life-threatening causes of chest painMinimize cost and hospitalization in patients with chest pain of benign etiology.

6. PAIN IN THE CHEST BUT ORIGIN??HEARTLUNGSOESOPHAGUSMUSCULOSKELETAL STRUCTURES OF THORAX NECK,OR SHOULDERABDOMENANXIETY MANIFESTATION

7. ISCHEMIC CARDIAC PAINV/SNON-CARDIAC PAIN

8. Cardiac causes of chest pain1.angina2.AMI3.pericarditis

9. case1Cardiac causeA 50 years old patient presented with retro sternal chest pain which radiates to the left arm, jaw, neck1.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 SyndromesStable anginaUnstableanginaNon-STE MISTE MIEvidence of necrosisNonePositivePositiveST-segment elevationST-segment depressionand/orT-wave inversionST-segment depressionand/or T-wave inversionECG earlyECG lateNo QNo QQ develops

11. Respiratory causes of chest pain1.Pulmonary embolismTension pneumothorax2.3.pneumonia

12. Case 2Respiratory causeA 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 findingsBreath soundsClinical diagnosis ?investigation

13. PULMONARY EMBOLISMRISK 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. HAEMOPTYSISTENSION PNEUMOTHORAXDIAGNOSIS

21. Vascular causes of chest pain1.Thoracic aortic dissection 2.Sickle cell anemia

22. case3Vascular causeA 33 years old woman during her pregnancy presented with severe sudden onset severe chest pain which radiates to the back between the shoulder baldesCharacter of pain : tearing or ripping sensationPrecipitating factors: Hypertension Connective tissue disorderDiagnosis ?