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 PAIN DR JAYANTA PAUL 1ST YEAR PGT, DEPT OF MEDICINE BURDWAN MEDICAL COLLEGE

3. 2 million hospitalizations annually with cost of more than $8 billion

4. Cardiac etiology found in less than one third

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

14. CLINICAL FEATURES DEPEND ON SIZE

15. FAINTNESS OR COLLAPSE

16. CENTRAL CHEST PAIN

17. APPREHENSION

18. SEVERE DYSPNOEA

19. PLEURITIC PAIN

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 ?

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

33. ABRUPT ONST

34. COLLAPSE

35. MARFAN`S SYNDROME

36. PT APPEARS TO BE IN SHOCK

37. BP---NORMAL OR reduced

38. ASYMMETRY OF PULSES

39. MI

40. PARAPLEGIA(SPINAL)

41. ACUTE ABDOMEN(MESENTERIC CAELIAC)

42. RENAL FAILURE

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