- Acute chest pain is a common reason for emergency department visits, accounting for around 10% of non-injury cases. It can be caused by cardiac, pulmonary, gastrointestinal, or other issues.
- Clinicians focus on immediately recognizing and ruling out life-threatening causes like acute coronary syndrome, aortic dissection, pulmonary embolism. However, patients may appear well despite serious underlying issues.
- Clinical prediction tools that incorporate history, physical exam findings, ECG, and cardiac troponin results can help accurately identify or rule out acute coronary syndrome when distinguishing it from non-cardiac chest pain.
The document provides an overview of brain CT interpretation for radiologists. It begins with how to systematically read a brain CT, covering the gross brain anatomy visible on CT. It then discusses the CT appearance and characteristics of traumatic brain injuries such as extra-axial hemorrhages and intracerebral injuries. Next, it covers ischemic and hemorrhagic strokes, describing the CT signs and distinguishing features. Finally, it discusses various types of non-traumatic intracranial hemorrhages that may be seen on brain CT. The document uses example clinical cases to demonstrate applying the principles of brain CT interpretation.
This document provides an overview of common CT findings in acute intracranial pathology, including trauma and stroke. Key points include:
- Extradural hematomas appear as biconvex lenses, while subdural hematomas are crescent shaped. Intraparenchymal hemorrhages can cause mass effect.
- Ischemic strokes appear as low density areas that obscure gray-white matter differentiation. Hemorrhagic strokes are centered in basal ganglia.
- Subarachnoid hemorrhage has a classic "five-pointed star" appearance around the circle of Willis. It can extend into ventricles and cause hydrocephalus.
- Vasogenic edema spares
The abdominal aorta continues from the descending thoracic aorta and supplies blood to the abdominal organs and lower limbs. It lies slightly left of the spine and divides into the common iliac arteries. Abdominal aortic aneurysms are focal dilations that are 1.5 times larger than normal diameter and can be saccular or fusiform in shape. Ultrasound is used to diagnose and measure aneurysms longitudinally, transversely, and with color Doppler to identify flow patterns. Measurements of greater than 5.5 cm indicate risk of rupture.
Intracranial bleeding encompasses all bleeds that may occur within the cranial cavity including Epidural, Subdural, Sub arachnoid, intraparenchymal and Intraventricular haemorrhages. all are discussed in these slides and relevant references are provided for detailed information.
It is important to note that medicine is not learnt online but through series of organised events under specialised supervision in recognised institutions of learning.
Radiological anatomy of pancreas and spleenPankaj Kaira
This document provides an overview of the radiological anatomy of the pancreas and spleen. It describes the locations and structures of the pancreas including the head, neck, body and tail. It also describes the pancreatic duct and its branches. For the spleen it describes the location, size, weight and blood supply. It then discusses several anatomical variations and congenital anomalies that can occur for both the pancreas and spleen such as pancreas divisum, annular pancreas, ectopic pancreas, polysplenia, splenosis and wandering spleen.
Chest pain Case Presentation with managementMuqtasidkhan
CASE presentation of chest pain types, causes, investigations, management. cardiac vs non cardiac pain. life threatening chest pain. MI, ACS, PNEUMOTHORAX, PE, GERD, AORTIC DISSECTION.
This document discusses the approach to pediatric chest imaging in the emergency room. It outlines the various radiological modalities used for pediatric chest imaging including chest x-rays, ultrasound, CT scans, and MRI. It then discusses the different thoracic emergencies seen in infants, preschool-aged children, and school-aged children. Specific conditions covered include neonatal respiratory distress, infections, congenital anomalies, foreign bodies, and more. Diagnostic findings and treatment approaches are provided for each condition.
The document provides an overview of brain CT interpretation for radiologists. It begins with how to systematically read a brain CT, covering the gross brain anatomy visible on CT. It then discusses the CT appearance and characteristics of traumatic brain injuries such as extra-axial hemorrhages and intracerebral injuries. Next, it covers ischemic and hemorrhagic strokes, describing the CT signs and distinguishing features. Finally, it discusses various types of non-traumatic intracranial hemorrhages that may be seen on brain CT. The document uses example clinical cases to demonstrate applying the principles of brain CT interpretation.
This document provides an overview of common CT findings in acute intracranial pathology, including trauma and stroke. Key points include:
- Extradural hematomas appear as biconvex lenses, while subdural hematomas are crescent shaped. Intraparenchymal hemorrhages can cause mass effect.
- Ischemic strokes appear as low density areas that obscure gray-white matter differentiation. Hemorrhagic strokes are centered in basal ganglia.
- Subarachnoid hemorrhage has a classic "five-pointed star" appearance around the circle of Willis. It can extend into ventricles and cause hydrocephalus.
- Vasogenic edema spares
The abdominal aorta continues from the descending thoracic aorta and supplies blood to the abdominal organs and lower limbs. It lies slightly left of the spine and divides into the common iliac arteries. Abdominal aortic aneurysms are focal dilations that are 1.5 times larger than normal diameter and can be saccular or fusiform in shape. Ultrasound is used to diagnose and measure aneurysms longitudinally, transversely, and with color Doppler to identify flow patterns. Measurements of greater than 5.5 cm indicate risk of rupture.
Intracranial bleeding encompasses all bleeds that may occur within the cranial cavity including Epidural, Subdural, Sub arachnoid, intraparenchymal and Intraventricular haemorrhages. all are discussed in these slides and relevant references are provided for detailed information.
It is important to note that medicine is not learnt online but through series of organised events under specialised supervision in recognised institutions of learning.
Radiological anatomy of pancreas and spleenPankaj Kaira
This document provides an overview of the radiological anatomy of the pancreas and spleen. It describes the locations and structures of the pancreas including the head, neck, body and tail. It also describes the pancreatic duct and its branches. For the spleen it describes the location, size, weight and blood supply. It then discusses several anatomical variations and congenital anomalies that can occur for both the pancreas and spleen such as pancreas divisum, annular pancreas, ectopic pancreas, polysplenia, splenosis and wandering spleen.
Chest pain Case Presentation with managementMuqtasidkhan
CASE presentation of chest pain types, causes, investigations, management. cardiac vs non cardiac pain. life threatening chest pain. MI, ACS, PNEUMOTHORAX, PE, GERD, AORTIC DISSECTION.
This document discusses the approach to pediatric chest imaging in the emergency room. It outlines the various radiological modalities used for pediatric chest imaging including chest x-rays, ultrasound, CT scans, and MRI. It then discusses the different thoracic emergencies seen in infants, preschool-aged children, and school-aged children. Specific conditions covered include neonatal respiratory distress, infections, congenital anomalies, foreign bodies, and more. Diagnostic findings and treatment approaches are provided for each condition.
Congestive heart failure can cause two types of pulmonary edema seen on chest x-rays: pulmonary interstitial edema and pulmonary alveolar edema. Pulmonary interstitial edema appears as thickening of interlobular septa, Kerley B lines, peribronchial cuffing, thickening of fissures, and subpleural fluid. Pulmonary alveolar edema creates a fluffy, bat-wing pattern in the lungs. Left atrial pressure correlates with the severity and type of pulmonary edema seen on chest x-rays.
Doppler ultrasound of lower limb arteriesSamir Haffar
This document provides information on Doppler ultrasound of lower limb arteries. It begins with the anatomy of lower limb arteries including the abdominal aorta, iliac arteries, femoral arteries, and crural arteries. It then discusses normal Doppler ultrasound findings of lower limb arteries including normal arterial diameters, waveforms, and velocities. Finally, it covers duplex ultrasound criteria for arterial evaluation and various causes of lower limb arterial diseases such as atherosclerosis, thrombosis, aneurysms, and arterial occlusions.
The liver is the largest solid organ located in the right upper quadrant of the abdomen. It is divided into eight segments based on vascular and biliary anatomy. The document describes the normal anatomy of the liver and common variations. It also discusses ultrasound techniques for imaging the liver and provides details on identifying different liver lesions including cysts, benign and malignant tumors, infections, and vascular anomalies on ultrasound scans.
Ultrasound of the urinary tract - Renal infectionsSamir Haffar
Ultrasound can detect various renal infections including:
1) Acute pyelonephritis seen as renal enlargement, decreased echogenicity, and loss of corticomedullary differentiation on ultrasound.
2) Renal abscesses appear as hypoechoic masses with thick irregular walls that increase in distinctness over time.
3) Pyohydronephrosis is infection of the obstructed collecting system seen as echogenic debris and fluid-fluid levels.
4) Emphysematous pyelonephritis involves gas in the renal parenchyma seen as high amplitude echoes and dirty shadowing.
The document provides an overview of using focused thoracic ultrasound to evaluate normal and abnormal findings in the thorax, including how to identify pleural effusions, consolidated lung, pneumothorax, and interstitial syndrome. It describes the sonographic appearances and characteristics of these common thoracic pathologies and highlights the importance of ultrasound in diagnostic and procedural guidance. The objectives are to teach the sonoanatomy of the thorax and recognize ultrasound signs that can help distinguish between normal and diseased lung tissue.
Ultrasound of acute & chronic cholecystitisSamir Haffar
This document discusses ultrasound findings related to cholecystitis. It describes the ultrasound appearance of acute cholecystitis, including signs like gallbladder wall thickening, pericholecystic fluid, and hyperemia on Doppler. Complications of acute cholecystitis are also reviewed, such as emphysematous cholecystitis where gas is visible in the gallbladder wall. Chronic cholecystitis is also summarized, noting findings like gallstones, wall thickening, and occasionally calcification or nodules indicative of xanthogranulomatous cholecystitis.
This document provides an overview of chest ultrasound techniques for critically ill patients. It describes the normal ultrasound patterns seen in the lungs including the pleural line, lung sliding, A-lines, and seashore sign. Abnormal patterns are also outlined such as pneumothorax, interstitial edema, alveolar edema, and alveolar consolidation. Techniques for identifying pleural effusions are also reviewed. The document concludes with a brief discussion of the BLUE protocol and management of single ventricle patients.
A 65-year-old male smoker presented with cough, chest pain, and breathlessness for 1 month with weight loss and loss of appetite. An x-ray showed a well-defined anterior mass that overlapped the hilum, indicating it was located in the anterior mediastinum. Differential diagnoses of anterior mediastinal masses include thymoma, teratoma, thyroid goiter or neoplasm, and lymphoma. The mass's location was identified as anterior mediastinal using the hilum overlay sign, where an anterior mass will overlap the main pulmonary arteries.
1) Focused Assessment with Sonography for Trauma (FAST) exam is useful for rapidly detecting fluid in trauma patients. Studies have found FAST to be more sensitive than chest X-ray or clinical exam alone in detecting hemothorax and pneumothorax.
2) Research has shown ultrasound to have higher sensitivity (88%) and specificity (100%) compared to chest X-ray (52% sensitivity, 99% specificity) for diagnosing pneumothorax.
3) Ultrasound signs like the sliding lung sign and seashore sign can help identify pneumothorax with reported sensitivities of 81-93% and specificities around 90%. FAST scanning takes less than a minute and
Segmental approach to Congenital Heart DiseaseTanat Tabtieang
The document describes the Van Praagh classification system for congenital heart disease, which uses a three-part notation to describe the visceroatrial situs, ventricular loop orientation, and great vessel arrangement. It first reviews related embryology, then outlines the three steps of the classification system: 1) determining the visceroatrial situs as situs solitus, situs inversus, or situs ambiguus, 2) assessing the ventricular loop orientation, and 3) evaluating the position and relationship of the great vessels. Key anatomic features are described to identify each component of the classification.
This document provides an overview of cardiac arrhythmias, including definitions and descriptions of normal sinus rhythm and various arrhythmias. It discusses the cardiac conduction system and mechanisms that can cause arrhythmias, such as abnormal impulse formation or conduction. Specific arrhythmias summarized include sinus bradycardia, sinus tachycardia, premature atrial contractions, supraventricular tachycardia, atrial fibrillation, atrial flutter, and atrial tachycardia. For each arrhythmia, the document provides information on heart rate, rhythm, P wave presence/morphology, and other ECG characteristics.
- Ultrasound of the inferior vena cava (IVC) can help assess intravascular volume status and guide fluid management. Measuring the diameter and collapse of the IVC during respiration provides a noninvasive estimate of central venous pressure.
- A case presentation describes a cirrhotic patient with hyponatremia whose IVC ultrasound showed 100% collapse, suggesting intravascular volume depletion. Based on this the patient was given normal saline and fluid restrictions were tightened to treat their mixed hyponatremia.
- Proper technique involves imaging the IVC longitudinally below the xiphoid process or in the mid-axillary
This document provides a 10 step process for interpreting ECGs:
1. Identify patient information and ensure proper calibration
2. Analyze rhythm, rate, axis
3. Examine PR interval and segments
4. Assess QRS morphology, duration, and amplitude
5. Evaluate ST segments and T waves
6. Measure QT interval
7. Interpret signs of ischemia, injury, or infarction
8. Consider additional conditions like electrolyte imbalances or cardiac abnormalities
9. Review dysrhythmia examples
10. Note any miscellaneous findings like pericarditis or right bundle branch block
Imaging prostatitis ,urethritis Dr Ahmed EsawyAHMED ESAWY
Imaging prostatitis ,urethritis dr ahmed esawy
IMAGING OF LOWER URINARY TRACT INFECTION LUTI
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound TRANSRECTAL ULTRASOUND images
Cystitis
Prostatitis
urethritis
Orchitis
Epidydmitis
Epidydmo-orchitis
funiculitis
Vastitis/differentitis
Seminal vesiculitis
Radiology Spotters mixed Bag Collection for post graduates student .PPTDr pradeep Kumar
Radiology Spotters collection by Dr Pradeep. nice collection of radiology spotter made by or collected by Dr. Pradeep, this is a collection of confusing spotter and very important spotter commonly asked in exams, our references is radiopaedia, learning radiology and Aunt Minnie.. Thanks.
This document provides an overview of the primary, secondary, and delayed effects of cerebral trauma. It discusses various types of fractures, extra-axial hemorrhages including epidural hematomas, subdural hematomas, subarachnoid hemorrhage, and intraventricular hemorrhage. It also covers intra-axial injuries such as cortical contusions, intraparenchymal hematomas, and diffuse axonal injury. For each type of injury, the document discusses etiology, location, radiographic features, and grading where applicable. It includes various CT and MRI images to illustrate examples of different traumatic brain injuries.
Chest pain is a common complaint presenting to emergency departments. A thorough history and physical exam is important to identify life-threatening causes such as acute coronary syndrome, pulmonary embolism, aortic dissection, tension pneumothorax, and esophageal rupture. Initial evaluation should focus on ABCs and obtaining an EKG to identify ST segment changes concerning for acute myocardial infarction. Risk stratification using cardiac markers and diagnostic imaging can help determine need for further intervention or conservative management.
Congestive heart failure can cause two types of pulmonary edema seen on chest x-rays: pulmonary interstitial edema and pulmonary alveolar edema. Pulmonary interstitial edema appears as thickening of interlobular septa, Kerley B lines, peribronchial cuffing, thickening of fissures, and subpleural fluid. Pulmonary alveolar edema creates a fluffy, bat-wing pattern in the lungs. Left atrial pressure correlates with the severity and type of pulmonary edema seen on chest x-rays.
Doppler ultrasound of lower limb arteriesSamir Haffar
This document provides information on Doppler ultrasound of lower limb arteries. It begins with the anatomy of lower limb arteries including the abdominal aorta, iliac arteries, femoral arteries, and crural arteries. It then discusses normal Doppler ultrasound findings of lower limb arteries including normal arterial diameters, waveforms, and velocities. Finally, it covers duplex ultrasound criteria for arterial evaluation and various causes of lower limb arterial diseases such as atherosclerosis, thrombosis, aneurysms, and arterial occlusions.
The liver is the largest solid organ located in the right upper quadrant of the abdomen. It is divided into eight segments based on vascular and biliary anatomy. The document describes the normal anatomy of the liver and common variations. It also discusses ultrasound techniques for imaging the liver and provides details on identifying different liver lesions including cysts, benign and malignant tumors, infections, and vascular anomalies on ultrasound scans.
Ultrasound of the urinary tract - Renal infectionsSamir Haffar
Ultrasound can detect various renal infections including:
1) Acute pyelonephritis seen as renal enlargement, decreased echogenicity, and loss of corticomedullary differentiation on ultrasound.
2) Renal abscesses appear as hypoechoic masses with thick irregular walls that increase in distinctness over time.
3) Pyohydronephrosis is infection of the obstructed collecting system seen as echogenic debris and fluid-fluid levels.
4) Emphysematous pyelonephritis involves gas in the renal parenchyma seen as high amplitude echoes and dirty shadowing.
The document provides an overview of using focused thoracic ultrasound to evaluate normal and abnormal findings in the thorax, including how to identify pleural effusions, consolidated lung, pneumothorax, and interstitial syndrome. It describes the sonographic appearances and characteristics of these common thoracic pathologies and highlights the importance of ultrasound in diagnostic and procedural guidance. The objectives are to teach the sonoanatomy of the thorax and recognize ultrasound signs that can help distinguish between normal and diseased lung tissue.
Ultrasound of acute & chronic cholecystitisSamir Haffar
This document discusses ultrasound findings related to cholecystitis. It describes the ultrasound appearance of acute cholecystitis, including signs like gallbladder wall thickening, pericholecystic fluid, and hyperemia on Doppler. Complications of acute cholecystitis are also reviewed, such as emphysematous cholecystitis where gas is visible in the gallbladder wall. Chronic cholecystitis is also summarized, noting findings like gallstones, wall thickening, and occasionally calcification or nodules indicative of xanthogranulomatous cholecystitis.
This document provides an overview of chest ultrasound techniques for critically ill patients. It describes the normal ultrasound patterns seen in the lungs including the pleural line, lung sliding, A-lines, and seashore sign. Abnormal patterns are also outlined such as pneumothorax, interstitial edema, alveolar edema, and alveolar consolidation. Techniques for identifying pleural effusions are also reviewed. The document concludes with a brief discussion of the BLUE protocol and management of single ventricle patients.
A 65-year-old male smoker presented with cough, chest pain, and breathlessness for 1 month with weight loss and loss of appetite. An x-ray showed a well-defined anterior mass that overlapped the hilum, indicating it was located in the anterior mediastinum. Differential diagnoses of anterior mediastinal masses include thymoma, teratoma, thyroid goiter or neoplasm, and lymphoma. The mass's location was identified as anterior mediastinal using the hilum overlay sign, where an anterior mass will overlap the main pulmonary arteries.
1) Focused Assessment with Sonography for Trauma (FAST) exam is useful for rapidly detecting fluid in trauma patients. Studies have found FAST to be more sensitive than chest X-ray or clinical exam alone in detecting hemothorax and pneumothorax.
2) Research has shown ultrasound to have higher sensitivity (88%) and specificity (100%) compared to chest X-ray (52% sensitivity, 99% specificity) for diagnosing pneumothorax.
3) Ultrasound signs like the sliding lung sign and seashore sign can help identify pneumothorax with reported sensitivities of 81-93% and specificities around 90%. FAST scanning takes less than a minute and
Segmental approach to Congenital Heart DiseaseTanat Tabtieang
The document describes the Van Praagh classification system for congenital heart disease, which uses a three-part notation to describe the visceroatrial situs, ventricular loop orientation, and great vessel arrangement. It first reviews related embryology, then outlines the three steps of the classification system: 1) determining the visceroatrial situs as situs solitus, situs inversus, or situs ambiguus, 2) assessing the ventricular loop orientation, and 3) evaluating the position and relationship of the great vessels. Key anatomic features are described to identify each component of the classification.
This document provides an overview of cardiac arrhythmias, including definitions and descriptions of normal sinus rhythm and various arrhythmias. It discusses the cardiac conduction system and mechanisms that can cause arrhythmias, such as abnormal impulse formation or conduction. Specific arrhythmias summarized include sinus bradycardia, sinus tachycardia, premature atrial contractions, supraventricular tachycardia, atrial fibrillation, atrial flutter, and atrial tachycardia. For each arrhythmia, the document provides information on heart rate, rhythm, P wave presence/morphology, and other ECG characteristics.
- Ultrasound of the inferior vena cava (IVC) can help assess intravascular volume status and guide fluid management. Measuring the diameter and collapse of the IVC during respiration provides a noninvasive estimate of central venous pressure.
- A case presentation describes a cirrhotic patient with hyponatremia whose IVC ultrasound showed 100% collapse, suggesting intravascular volume depletion. Based on this the patient was given normal saline and fluid restrictions were tightened to treat their mixed hyponatremia.
- Proper technique involves imaging the IVC longitudinally below the xiphoid process or in the mid-axillary
This document provides a 10 step process for interpreting ECGs:
1. Identify patient information and ensure proper calibration
2. Analyze rhythm, rate, axis
3. Examine PR interval and segments
4. Assess QRS morphology, duration, and amplitude
5. Evaluate ST segments and T waves
6. Measure QT interval
7. Interpret signs of ischemia, injury, or infarction
8. Consider additional conditions like electrolyte imbalances or cardiac abnormalities
9. Review dysrhythmia examples
10. Note any miscellaneous findings like pericarditis or right bundle branch block
Imaging prostatitis ,urethritis Dr Ahmed EsawyAHMED ESAWY
Imaging prostatitis ,urethritis dr ahmed esawy
IMAGING OF LOWER URINARY TRACT INFECTION LUTI
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound TRANSRECTAL ULTRASOUND images
Cystitis
Prostatitis
urethritis
Orchitis
Epidydmitis
Epidydmo-orchitis
funiculitis
Vastitis/differentitis
Seminal vesiculitis
Radiology Spotters mixed Bag Collection for post graduates student .PPTDr pradeep Kumar
Radiology Spotters collection by Dr Pradeep. nice collection of radiology spotter made by or collected by Dr. Pradeep, this is a collection of confusing spotter and very important spotter commonly asked in exams, our references is radiopaedia, learning radiology and Aunt Minnie.. Thanks.
This document provides an overview of the primary, secondary, and delayed effects of cerebral trauma. It discusses various types of fractures, extra-axial hemorrhages including epidural hematomas, subdural hematomas, subarachnoid hemorrhage, and intraventricular hemorrhage. It also covers intra-axial injuries such as cortical contusions, intraparenchymal hematomas, and diffuse axonal injury. For each type of injury, the document discusses etiology, location, radiographic features, and grading where applicable. It includes various CT and MRI images to illustrate examples of different traumatic brain injuries.
Chest pain is a common complaint presenting to emergency departments. A thorough history and physical exam is important to identify life-threatening causes such as acute coronary syndrome, pulmonary embolism, aortic dissection, tension pneumothorax, and esophageal rupture. Initial evaluation should focus on ABCs and obtaining an EKG to identify ST segment changes concerning for acute myocardial infarction. Risk stratification using cardiac markers and diagnostic imaging can help determine need for further intervention or conservative management.
Visceral pain from chest organs is poorly localized and described as dull, while parietal pain from the chest wall is sharp and localized. Chest pain evaluations start with ABCs and aspirin, then involve EKG, monitoring, and pain relief. A thorough history and physical exam aim to differentiate causes like acute coronary syndrome, aortic dissection, pulmonary embolism, pneumonia, or musculoskeletal issues. Diagnostic testing may include markers, echocardiogram, Wells criteria, CT scans, and management depends on the specific diagnosis and stability of the patient.
This document provides an overview of chest pain, including the pathophysiology, diagnosis, and treatment of life-threatening causes. It discusses the epidemiology, history, physical exam findings, diagnostic testing and treatment for conditions like acute coronary syndrome, pulmonary embolism, aortic dissection, tension pneumothorax, and esophageal rupture. The differential diagnosis for chest pain is also reviewed, along with algorithms for evaluating and managing common conditions presenting with chest pain like pulmonary embolism and acute coronary syndrome.
The document discusses the evaluation and management of chest pain in primary care settings. It outlines that chest pain is a common complaint accounting for 5-8% of emergency room visits. The most common causes differ based on the healthcare setting, with musculoskeletal and gastrointestinal issues more common in primary care, while serious cardiovascular diseases are more prevalent in emergency rooms. The evaluation involves obtaining a thorough history including characteristics of the pain, risk factors assessment, physical exam, electrocardiogram and cardiac biomarkers to differentiate between urgent versus non-urgent causes and rule out conditions like heart attacks, pulmonary embolisms and aortic dissections. Clinical decision rules can help determine the likelihood of coronary artery disease, myocardial infarction or pulmonary embolism as the cause.
This document discusses cardiovascular disease, specifically a case of a 66-year-old man experiencing chest pain who was diagnosed with an acute myocardial infarction. It describes the patient's medical history, symptoms, examination findings, diagnostic tests and results including ECGs showing ST elevation, and angiogram revealing a 100% blockage of the left anterior descending artery treated with stenting. Differential diagnoses including aortic dissection and pulmonary embolism are also discussed.
This document provides guidance on evaluating adults presenting to the emergency department with chest pain. It discusses the differential diagnosis for chest pain, which can be caused by conditions affecting the heart, lungs, esophagus or other organs. The most common causes are acute coronary syndrome (15-30% of cases) and aortic dissection. It emphasizes obtaining a detailed history of the chest pain characteristics and risk factors. Features like sudden onset, severity, radiation of pain and associated symptoms can help determine if life-threatening conditions like pulmonary embolism or aortic dissection are possible. A focused physical exam and diagnostic testing are also recommended to identify the underlying cause.
Evaluation of the adult chest pain in emergency departmentfereshteh setva
Evaluation of the adult with chest pain in the emergency department is a big challenge and this presentation is very useful to know the major cause of chest pain and approach them
Summary Cardiovascular disease or CVD accounts for the maximum.pdfsdfghj21
The document discusses a case study of a 66-year-old male patient who presented to the emergency room with 24 hours of intense chest pain. After examination, electrocardiograms, and cardiac catheterization, the patient was diagnosed with an anterolateral myocardial infarction caused by a 100% blockage of the middle left anterior descending artery, which was treated with stents. Differential diagnoses discussed included aortic dissection and pulmonary embolism, but the presentation and test results were most consistent with an acute myocardial infarction.
This document discusses an approach to evaluating and diagnosing the cause of chest pain. It begins by outlining the importance of taking a thorough history, including details on location, radiation, timing, aggravating/relieving factors, and associated symptoms. Physical exam findings that may provide clues are also reviewed. Key tests for evaluation include ECG, cardiac biomarkers, echocardiogram, and imaging studies. Differential diagnoses discussed include angina, aortic dissection, pulmonary embolism, gastroesophageal causes, musculoskeletal causes, and psychological factors. Diagnosis involves synthesizing all available clinical information.
A 28-year-old male was brought to the emergency room after a motor vehicle accident. He complained of chest pain, a forehead wound, and right forearm pain. Examination found he was conscious with stable vital signs. Chest x-ray revealed an abnormal aortic knob and widened mediastinum. CT angiogram confirmed a traumatic aortic tear. Despite treatment, his condition deteriorated with low blood pressure and increased pain. Aortography then definitively diagnosed aortic rupture, which requires urgent surgical repair for survival.
This document provides information on evaluating and diagnosing chest pain. It discusses:
- The importance of history taking in determining the cause of chest pain.
- Common life-threatening causes of chest pain like myocardial infarction, aortic dissection, pulmonary embolism, and tension pneumothorax.
- How to assess chest pain through physical examination, ECG, cardiac enzymes, imaging studies, and other investigations.
- Distinguishing cardiac from non-cardiac chest pain and differentiating conditions like angina, unstable angina, and STEMI based on features.
Acute myocardial infarction critical care cardiologyGiovanna Trujillo
This document discusses the evaluation and diagnosis of acute chest pain in the intensive care unit setting. It describes that chest pain requires immediate evaluation to diagnose potentially life-threatening causes like acute myocardial infarction. While AMI is a major concern, there are many cardiac and non-cardiac causes of chest pain that require testing and diagnostic evaluation. Common causes discussed in detail include pericarditis, pulmonary embolism, musculoskeletal pain, and acute myocarditis.
This document discusses the approach to evaluating and managing chest pain. It notes that chest pain accounts for millions of emergency department visits annually costing over $8 billion. The causes of chest pain are discussed, with musculoskeletal, gastrointestinal, and cardiac being most common. The initial approach to a patient with chest pain involves oxygen, IV access, monitoring, and an early ECG. A thorough history, physical exam including listening to heart and lungs, ECG, cardiac enzymes, CXR and other tests are used to evaluate the cause. Life-threatening conditions like myocardial infarction, pulmonary embolism, aortic dissection, and pericarditis require prompt diagnosis and treatment.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include cancer, obesity, pregnancy, prolonged immobility, and genetic hypercoagulable states. Diagnosis involves assessing clinical probability, d-dimer testing, imaging like CT scans or V/Q scans, and echocardiography. Treatment consists of anticoagulants like heparin or warfarin to prevent further clotting while the body breaks down existing clots.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of cases resulting in PE. Risk factors include immobilization, surgery, cancer, and estrogen use. Diagnosis involves assessing clinical probability based on symptoms and risk factors, followed by tests like D-dimer, chest imaging, ultrasound, V/Q scan, CT, or angiogram. Treatment aims to prevent further clotting with anticoagulants like heparin and warfarin, provide supportive care, and in some severe cases utilize thrombolysis or embolectomy.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include older age, cancer, obesity, surgery, trauma, and genetic or acquired hypercoagulable states. Diagnosis involves assessing clinical probability, blood tests like D-dimer, imaging like CT scans or ventilation-perfusion scans, and echocardiography. Treatment focuses on anticoagulation to prevent further clotting and allow natural lysis, along with supportive care and thrombolysis or embolectomy in severe cases.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include cancer, obesity, pregnancy, prolonged immobility, and genetic predispositions. Diagnosis involves evaluating symptoms, physical exam findings, blood tests like D-dimer, imaging like CT scans and V/Q scans, and echocardiograms. Treatment focuses on anticoagulation with heparin or warfarin to prevent further clotting while the body breaks down existing clots.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of cases resulting in PE. Risk factors include cancer, obesity, pregnancy, prolonged immobility, and genetic predispositions. Diagnosis involves evaluating symptoms, medical history, imaging tests like CT scans and ventilation-perfusion scans, and blood tests. Treatment focuses on anticoagulation to prevent further clotting and allow natural dissolution, with thrombolysis or embolectomy for severe cases.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include older age, cancer, obesity, surgery, trauma, and genetic or acquired hypercoagulable states. Diagnosis involves assessing clinical probability based on symptoms and risk factors, then confirming with tests like D-dimer, chest imaging, ventilation-perfusion scanning, pulmonary angiography, or CT pulmonary angiography. Treatment focuses on anticoagulation to prevent further clotting while allowing natural lysis of existing thrombi.
Similar to Chest Pain in the Emergency Department.pptx (20)
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
2. Overview
Acute chest pain is one of the most frequent reasons to attend the ED, accounting for
approximately 10% of non- injury related visits
Patients present with a spectrum of signs and symptoms reflecting the many potential etiologies
of chest pain. Diseases of the heart, aorta, lungs, esophagus, stomach, mediastinum, pleura, and
abdominal viscera may all cause chest discomfort.
Clinicians in the ED focus on the immediate recognition and exclusion of life-threatening causes
of chest pain. Patients with life-threatening etiologies for chest pain may appear deceptively well,
manifesting neither vital sign nor physical examination abnormalities.
3. Epidemiology
Half of the patients presenting with chest pain can be discharged from the ED without further hospitalization .
Of the patients admitted to the hospital, only about 25% have a final diagnosis of an ACS
. Another 25% of the patients will be discharged with a diagnosis of angina pectoris or with other non- ischaemic cardiac
problems
. In the remaining half of the admitted patients, the final diagnosis will be unspecified chest pain (26%) or a non- cardiac
cause (27%) .
Acute vascular emergencies and PE constitute only a tiny minority (2– 3%) of the patients
Approximately 2% of chest pain patients with an ACS are mistakenly discharged from the ED
Of patients presenting to the ED without diagnosis- specific symptoms, AMI was the final diagnosis in 1.6%
4. Pathophysiology
The cardiovascular system, respiratory system, part of the gastrointestinal system, and the great vessels
give off afferent visceral input via common thoracic autonomic ganglia. Painful stimuli in any of the
aforementioned systems are usually sensed as originating from the chest. However, due to the fact that
afferent nerve fibers overlap in the dorsal ganglia, pain in the thorax may be experienced at any point
between the umbilicus and the ear, as well as in the upper limbs.
9. Case 1
A 42-year-old, previously healthy woman presents to the emergency
department with 45 minutes of crushing substernal chest pain. On arrival to
the emergency department, the pain is completely relieved by nitroglycerin,
the electrocardiogram (ECG) is unremarkable, and initial troponin level is
0.01 ng/mL (reference range, 0.00-0.08 ng/mL).
10. Case 2
A 74-year-old man with a myocardial infarction 3 years prior presents to
the emergency department with several days of intermittent burning
retrosternal chest pain. The ECG shows Q waves in leads II, III, and aVF that
were present on his last ECG 3 months prior;there are no new ischemic
changes.His initial troponin level is 0.14 ng/mL (reference range, 0.00-0.08
ng/mL).
12. History
General approach — Obtain a detailed history of the patient's chest pain, including:
●Onset of pain (eg, abrupt or gradual)
●Provocation/Palliation (which activities provoke pain; which alleviate pain)
●Quality of pain (eg, sharp, squeezing, pleuritic)
●Radiation (eg, shoulder, jaw, back)
●Site of pain (eg, substernal, chest wall, diffuse, localized)
●Timing (eg, constant or episodic, duration of episodes, when pain began)
13. Ask about prior diagnostic studies (eg, stress test or coronary CT angiography)
similar symptoms or prior procedures (eg, cardiac catheterization)
. Ask whether the discomfort is similar to prior illness.
Associated symptoms, such as nausea, vomiting, diaphoresis, dyspnea, syncope, and palpitations,
. Ask about risk factors for life-threatening illness, especially acute coronary syndrome, aortic dissection, and
pulmonary embolus,
●Comorbidities: hypertension, diabetes mellitus, peripheral vascular disease, malignancy
●Recent events: trauma, major surgery or medical procedures (eg, endoscopy), periods of immobilization (eg, long
plane ride)
●Other factors: cocaine use, cigarette use, family history
14. Physical Examination
Focuses on vital signs
Most often unremarkable in ACS
May point to other diagnosis or reveal complications of AMI
15. ECG
Should be obtained and interpreted within 10 minutes of patient presentation
Finding of ST segment elevation or equivalents should trigger rapid response (catheterization lab activation, or
fibrinolytic therapy) beware of causes other than STEMI
single ECG performed during the patient's initial presentation detects fewer than 50 percent of AMIs.
It's important to repeat the ECG as early as 10 minutes especially in case of ongoing chest pain
ECG can be normal or shows non ischemic findings in patients with evidence of AMI
Although ischemic changes on initial ECG was associated with poorer diagnosis
16.
17.
18.
19. CXR
A chest radiograph (CXR) is obtained in all chest pain patients with hemodynamic instability or a
potentially life-threatening diagnosis. A nondiagnostic CXR is typical in patients with ACS.
Approximately 90 percent of patients with aortic dissection will have some CXR abnormality
Can diagnose Pneumonia PTX
May show Cardiomegaly and pulmonary congestion
Pneumomediastinum left sided pneumo/hydrothorax suggests esophageal rupture
21. Echocardiograpgy and Other POCUS
An echocardiogram can also help in defining the extent of an infarction and in assessing overall function
of the left and right ventricles. In addition, an echocardiogram can help to identify complications, such as
acute mitral regurgitation, LV rupture, and pericardial effusion.
Absence of segmental wall-motion abnormality on echocardiography during active chest discomfort is a
highly reliable indicator of a nonischemic origin of symptoms, although echocardiography is of limited
value in patients whose symptoms have resolved or who have pre-existing wall-motion abnormalities.
Differential diagnosis with POCUS
22. Can we distinguish between cases of
ACS and non cardiac chest pain with
History Examination and ECG?
23. STEMI can be excluded by ECG and occurs in less than 25% of patients presenting with
symptoms concerning for ischemia.
The key distinction in the majority of patients is between NSTE-ACS and noncardiac chest pain.
Studies found that the accuracy of risk factors and symptoms for diagnosing ACS was generally
poor,some are specific more than sensitive.
Overall clinical impression,incorporating history and physical examination performed better,
but the best diagnostic tests were clinical prediction tools( eg,TIMI score, HEART score) that
incorporated historical elements along with the initial ECG and cardiac troponin results.
28. clinical prediction tools
Using 1 of the available clinical prediction tools at the initial evaluation gives the highest likelihood of
correctly identifying or excluding ACS. Physicians should use the results of the prediction tools when
deciding whether or not to forgo serial evaluation and testing.
29.
30.
31. Case 1
A 42-year-old, previously healthy woman
presents to the emergency department with
45 minutes of crushing substernal chest pain.
On arrival to the emergency department, the
pain is completely relieved by nitroglycerin,
the electrocardiogram (ECG) is unremarkable,
and initial troponin level is 0.01 ng/mL
(reference range, 0.00-0.08 ng/mL).
The patient, despite a story consistent with
typical angina, has a HEART risk score of 2. A
HEART risk score of 2 has an LR for the diagnosis
of ACS of 0.2, and the posttest probability is 3%.
Relief of her pain with nitroglycerin is unhelpful
for diagnosing or ruling out ACS. She could be
considered for anaccelerated diagnostic protocol
with early discharge if a second cardiac troponin
is negative
32. Case 2
A 74-year-old man with a myocardial
infarction 3 years prior presents to the
emergency department with several days of
intermittent burning retrosternal chest pain.
The ECG shows Q waves in leads II, III, and
aVF that were present on his last ECG 3
months prior;there are no new ischemic
changes.His initial troponin level is 0.14 ng/mL
(reference range, 0.00-0.08 ng/mL).
The patient has known CAD and is elderly. His
ECG does not show dynamic changes,and
troponin elevationnis mild.With a HEART
score of 6,he is at intermediate
risk(LR,2.4),yielding a post test probability of
26%.He should be admitted and treated for
ACS.