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78-year-old female who presents with crushing central chest pain for 20…
78-year-old female who presents with crushing central chest pain for 20 minutes
Radiation of pain
(Left) arm or jaw => Ischemic chest pain. Other sx: diaphoresis; dyspnea; hypotension; tachycardia/bradycardia/hypoxia depending on severity. More likely in patients with known risk, e.g. DM, HTN, hyperlipidemia, smoking, vasculitis. Coronary heart disease if the most common cause.
Angina, typically resolves in 3-5 min with rest/sublingual nitrates
Acute Coronary Syndrome
Unstable/new-onset angina. Other sx: episodes occur with rest/decreasing amts of effort; tachycardia; hypotension; third heart sound; lung crepitations; elevated JVP
Myocardial infarction. Other Sx: marked diaphoresis; dyspnea; vomiting; dizziness/fainting; anxiety
Tachyarrhythmias; vasospasm (Prinzmetal's angina)
Sympathetic stimulation e.g. drug abuse; thyrotoxicosis; pheochromocytoma
To the back
Sharp tearing pain radiating to back between scapulae => aortic dissection. Other sx: pain maximal at onset, improves with time; pain can radiate anywhere in the chest or into abdomen
Others
Pericarditis/myopericarditis (primarily pericarditic syndrome with minor myocardial involvement). Other sx: pleuritic chest pain relieved on sitting up. Other sx: percardial friction rub; signs of tamponade (hypotension, distended neck veins, muffled heart sounds); improved by sitting up and leaning forward
Myocarditis. Other sx: (fever; myalgias; muscle tenderness for viral); S3 and occasionally S4 gallops; pericardial friction rub and/or effusion
Herpes zoster. Other sx: chest pain may present before dermatomal rash
Associated symptoms
Cough => Respiratory
Pulmonary embolism. Other sx: pain similar to heart attack; sudden SOB; bloody cough/blood-tinged mucus if pulmonary infarction; wheezing; pallor/cyanosis; dizziness/fainting; tachycardia; tachypnea; look for swollen legs (DVT)
Pneumonia. Other sx: pleuritic pain associated with SOB; rigors; myalgias/arthralgias; decreased breath sounds; wheezing; bronchial breath sounds; dullness to percussion
Recent change in appetite => esophagitis (could be due to GERD). Other sx: dysphagia; odynophagia; heartburn; nausea/vomiting; lack of appetite; may radiate to the back/neck/jaw/arms
Blood in stool => Esophageal rupture. Other sx: dysphagia; nausea/vomiting; palpitations; fever; SOB
Others: pain can be reproduced on palpation => Costochondritis Other sx: worsens with inspiration or cough
Dyspnea
Stress cardiomyopathy. Other sx: syncope; signs of cardiogenic shock (hypotension, abnormal mental status)
Pneumothorax. Other sx: pleuritic chest pain