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Chest pain is a common reason for emergency room visits. According to the document, chest pain accounts for over 2 million ER visits per year in the US. It can be difficult to accurately diagnose the underlying cause of chest pain. The document discusses several cases of patients presenting with chest pain and the process of gathering a history, performing a physical exam, ordering tests, and considering potential diagnoses for each case, including acute myocardial infarction, pericarditis, pulmonary embolism, and aortic dissection.
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This document provides guidance on evaluating and managing chest pain. It lists common cardiac, pulmonary, aortic, chest wall, and esophageal causes of chest pain. It describes typical versus atypical chest pain characteristics and provides the Modified Wells Criteria for evaluating pulmonary embolism risk. Evaluation involves history, physical exam, EKG, and lab tests. The document reviews two case studies of patients presenting with chest pain and outlines diagnostic and treatment approaches.
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This document provides an overview of chest pain for medical professionals. It discusses the most common causes of chest pain, important characteristics to assess, life-threatening conditions to consider, appropriate diagnostic tests and initial management strategies. Key points include that 20% of emergency visits for chest pain are due to acute coronary syndrome, a thorough history and physical exam are essential for diagnosis, and ECG, cardiac enzymes and CXR are commonly performed initial tests.
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Approachto cp
1. The document discusses the approach to evaluating and categorizing different types of chest pain, including acute coronary syndrome.
2. Key factors in the initial evaluation of chest pain include obtaining a detailed history, performing a physical exam, 12-lead EKG, and cardiac biomarker testing to help determine if the chest pain is caused by life-threatening conditions like myocardial infarction.
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This document provides an overview and guidance on evaluating and managing patients presenting with chest pain. It reviews the differential diagnosis and initial management steps for life-threatening causes of chest pain like acute coronary syndromes, pulmonary embolism, aortic dissection, and pneumothorax. Specific cases are presented and managed, focusing on history, exam, testing, diagnosis, and treatment of conditions like NSTEMI, pulmonary embolism, and continued chest pain in ACS. Key reminders and order sets are referenced.
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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.
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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.
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Evaluation of Chest Pain in the Ambulatory Setting
This document discusses the evaluation of chest pain in an outpatient setting. It begins by stating that the initial goals are to rule out acute coronary syndrome (ACS) and other life-threatening conditions. Common causes of chest pain in an outpatient setting include chest wall pain, gastroesophageal reflux disease (GERD), and costochondritis. More serious potential causes include ACS, pulmonary embolism, aortic dissection, and pneumonia. The document reviews the likelihood ratios and characteristics for diagnosing various potential causes of chest pain. It also discusses appropriate use of stress testing and who should be urgently referred to the emergency department for evaluation.
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The document discusses the clinical approach to assessing patients presenting with non-cardiac chest pain. It outlines key objectives in rapidly and accurately evaluating these patients to form an accurate differential diagnosis and provide initial therapy. Chest pain is a common complaint, with cardiac and non-cardiac potential etiologies discussed. A focused history and physical exam can help differentiate causes like pulmonary embolism, pneumothorax, esophageal disorders, and musculoskeletal issues. Appropriate diagnosis and treatment depends on the suspected condition and patient stability.
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A 65-year-old female presents to the emergency room with chest pain and shortness of breath. Differentials for her chest pain include stable angina, unstable angina, myocardial infarction, and non-cardiac causes. An EKG and cardiac biomarkers like troponin and CK-MB levels can help determine if she is experiencing a cardiac event. On exam, vital signs and cardiac auscultation may provide clues to diagnose potential cardiac or non-cardiac causes of her chest pain.
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This document provides guidance on evaluating chest pain in primary care. It discusses:
- Taking a thorough history, which can lead to the correct diagnosis 80% of the time.
- Common causes of chest pain include musculoskeletal, GERD, angina, and some cases have no definitive diagnosis.
- ECG has low sensitivity for coronary ischemia. Imaging stress tests are recommended if ECG is uninterpretable or if the patient cannot exercise.
- Pharmacological stress tests use drugs like dobutamine if exercise is not possible, and different drugs are preferred for certain patients.
- The optimal test depends on the patient's symptoms, risk factors, and ECG findings, with stress echos and nuclear imaging
Prompt course cp 2019 ihab suliman
This document provides an overview of an orientation for new residents on approaching chest pain. It discusses the differential diagnosis for chest pain and lethal causes. It also covers evaluating chest pain, including vital signs, EKG, and physical exam findings. Five case studies are presented: 1) a 49-year-old male with severe chest pain and elevated troponin, 2) a 25-year-old female with aortic dissection, 3) a 25-year-old postpartum female with localized chest pain, 4) a 55-year-old female with chest pain after stopping warfarin, and 5) a 70-year-old female with chest pain after surgery who develops takotsubo cardiomyopathy.
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Chest pain can arise from many sources in the chest region. A thorough assessment of chest pain is important to determine the cause and appropriate treatment. Key factors to consider include characteristics of the pain like location, quality and duration, as well as associated symptoms. Potential life-threatening causes include acute coronary syndrome, pulmonary embolism and aortic dissection which require urgent evaluation. Other potential causes discussed are musculoskeletal, gastrointestinal, pulmonary and psychological conditions. A systematic approach is needed to distinguish between cardiac and non-cardiac etiologies of chest pain.
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Chest Pain-case 2
A 60-year-old Chinese woman presented with chest pain. She had a history of hypertension and diabetes for 10 years. Her chest pain was central, tight, and radiated to her jaw and left arm. She experienced nausea, sweating, and dyspnea. Physical exam revealed she was obese. Electrocardiogram showed ST segment depression and T inversion. Blood tests showed elevated cardiac enzymes. She was diagnosed with a non-ST elevation myocardial infarction based on her symptoms, risk factors, and test results.
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This document discusses two cases of chest pain with different diagnoses:
1) A 62-year-old man presented with chest pain and was diagnosed with a myocardial infarction based on ECG findings.
2) A 23-year-old woman presented with chest pain and cough and was diagnosed with acute pericarditis based on ECG and exam findings showing a pericardial rub.
Approachto cp
1. The document discusses the approach to evaluating and categorizing different types of chest pain, including acute coronary syndrome.
2. Key factors in the initial evaluation of chest pain include obtaining a detailed history, performing a physical exam, 12-lead EKG, and cardiac biomarker testing to help determine if the chest pain is caused by life-threatening conditions like myocardial infarction.
3. Patients are categorized as having possible acute ischemia, probable acute ischemia, or myocardial infarction based on their history, symptoms, physical exam findings, EKG results, and cardiac enzyme levels in order to determine the urgency of further testing and treatment.
Approach to Chest Pain
This document discusses the approach to evaluating chest pain, including differentiating typical vs atypical chest pain and providing a case example. It outlines evaluating a patient presenting with new chest pain by obtaining vital signs, EKG, and focused exam. Differentials for the case include PE, pneumonia, and MI. The Wells criteria and appropriate tests are reviewed, including D-dimer, CTPE, and V/Q scan to further evaluate for PE given the patient's moderate risk. Intravenous access is needed for CT angiogram to evaluate PE or aortic dissection.
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The document discusses chest pain, including its causes, characteristics, diagnosis and management. It provides objectives for medical students to understand life-threatening causes of chest pain like acute coronary syndrome, learn the importance of history and physical exam, and know initial investigations and management. Several chest pain scenarios are presented and key diagnostic features are highlighted. Initial treatment for acute coronary syndrome focuses on oxygen, nitrates, aspirin and monitoring. Secondary prevention involves medications like beta blockers, statins and lifestyle changes. Other causes like pulmonary embolism, pneumothorax and aortic dissection also have targeted treatment approaches outlined.
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The document discusses acute pulmonary embolism (PE). PE is common but difficult to diagnose, with nonspecific symptoms. It describes a case of a 48-year-old woman presenting with sudden dyspnea, tachycardia, and leg swelling who may have PE. Risk factors for PE include recent surgery or trauma, prolonged immobilization, and inherited or acquired hypercoagulable states. Diagnosis involves clinical scoring, D-dimer, imaging like CTPA, and treatment includes anticoagulation with heparin or warfarin.
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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.
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The document discusses several clinical case scenarios presented by "Dr. Bad" and "Dr. Good" to illustrate the importance of thorough clinical examination and consideration of alternative diagnoses rather than relying solely on initial impressions or test results. In Case 1, "Dr. Good" identifies pericarditis rather than reinfarction based on the nature of chest pain and auscultation findings. In Case 2, "Dr. Good" suspects and confirms upper GI bleed as the cause of syncope rather than assuming a cardiac cause. The document emphasizes looking for non-cardiac explanations and relying on clinical assessment over initial impressions.
Chest Pain.ppt
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.
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- 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.
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chest pain 2015 what else you want me to write here
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dolor dolor
- 1. Chest pain
- 3. Chest pain is difficult to interpret
- 5. Case 1: ECG
- 10. The importance of a history Swap JAMA 2005 1.9 Worse than previous angina or similar to previous MI 1.8 Described as pressure 2.0 Associated with nausea or vomiting 2.3 Radiation to left arm 2.4 Associated with exertion 4.1 Radiation to both arms or shoulder 4.7 Radiation to R arm or shoulder Positive likelihood ratio Pain Descriptor
- 11. The importance of a history Swap JAMA 2005 0.8 Not associated with exertion 0.3 Reproducible with palpation 0.3 Described as sharp 0.3 Described as positional 0.2 Describes as pleuritic Positive likelihood ratio Pain Descriptor
- 13. Markers of myocardial injury
- 15. PTCA, percutaneous transluminal coronary angioplasty. 5.0%- 6.5% 13%-15% 30% Pre-CCU Era CCU Era Reperfusion Era Improvement in Mortality
- 17. ECG
- 24. ECG
- 38. Case # 5 A 52-year-old man telephones his physician to report a 4-week history of episodic left-sided chest pain lasting 3 to 5 minutes, often occurring at rest, and resolving spontaneously. He is unsure whether the episodes are related to meals. He has not had any shortness of breath, orthopnea, exertional dyspnea, nausea or vomiting. History is significant for hyperlipidemia. Patient has been sedentary for the past several years until 3 months ago when he began exercising. The patient is experiencing significant stress related to his job; he is also in the midst of a divorce. During the course of the phone interview, the patient is asked to determine whether he feels any pain while pressing on his chest over the lateral aspects of the sternum. The patient reports that this maneuver does vaguely reproduce his pain.