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BD TLEAD 12 (Chest Pain) (Pulmonary (Pneumothorax, Pneumonia [pleuritic…
BD TLEAD 12 (Chest Pain)
Cardiovascular
Ischemic
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Severe anemia, hypoxia, hyperviscosity
Acute Coronary Syndrome
Myocardial Infarction
STEMI
Detection of a rise and/or fall of cardiac biomarker values (preferably cardiac troponin [cTn] with at least one value above the 99th percentile upper reference limit [URL]) and with at least one of the following:
•Symptoms of ischemia
•Development of pathologic Q waves in the electrocardiogram (ECG)
•New or presumed new significant ST-segment-T wave (ST-T) changes or new left bundle branch block (LBBB).
•Identification of an intracoronary thrombus by angiography or autopsy
•Imaging evidence of new loss of viable myocardium or a new regional wall motion [abnormality].
The likelihood of MI is higher if there is pain radiating to both arms, hypotension, an S3 gallop on physical examination,7 or
diaphoresis. Other factors predicting MI include age greater than 60 years, male sex, and prior MI. MI is less likely if pain is
sharp or pleuritic.
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Angina
Unstable Angina [even at rest; radiating pain to arm jaw shoulder neck, fatigue, nausea, sweating, weakness, dypsnea]
Angina [Classic angina pectoris is described as a pressure, heaviness, tightness, or constriction in the center or left of the chest that is precipitated by exertion and relieved by rest. It is generally not described as pain (sharp or dull), ache, or needles and pins.]
Hyperthyroidism, Hyperthermia
Non-Ischemic
Acute aortic dissection [abrupt severe pain (sharp/knife-like) ; Pain can occur in isolation or be associated with syncope, a cerebrovascular accident, acute coronary syndrome, heart failure, or other clinical symptoms or signs ; pallor, dry mouth]
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Pericarditis [pain better on bending forward, sharp pain on inspiration, pericardial rub]
Myocarditis [excessive fatigue, S3 / S4 gallop, unexplained sinus tachycardia[
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Gastrointestinal
Biliary disease (cholecystitis, choledocholithiasis) [Visceral, epigastric, interscapular colic, occurs after meals]
Peptic ulcer [Visceral, burning, epigastric, relief with food, antacids, normal ECG]
Esophageal
Rupture [Severe chest pain (can be neck to abdomen), difficulty swallowing, nausea, vomiting (with blood), tachypnea, tachycardia, fever, melena]
Spasm [Visceral, spontaneous, substernal, associated with cold liquids, relief with nitroglycerin]
Esophagitis (reflux, medication-related) [Visceral, substernal, worse with recumbency, no radiation, relief with food, antacids ; water brash]
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Pulmonary
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Pneumonia [pleuritic chest pain on inspiration, fever, egophony, dull to percussion]
Pulmonary embolism (PE) [acute dyspnea followed by chest pain (classically pleuritic in nature), cough, symptoms of deep venous thrombosis (LL swelling), tachycardia and hemoptysis (less likely).]
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Psychogenic
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Anxiety disorders (hyperventilation, panic attacks)
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MSK
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Pectoral muscle strain [Superficial, positional, worse with movement, local tenderness]
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