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78 yr FM Crushing central pain for 20 min (Respiratory (Pneumothorax (Hx:…
78 yr FM Crushing central pain for 20 min
Cardiac
Ischemic
Acute Coronary Syndrome
Unstable Angina
Fm Hx: Hypertension, hyperlipidemia S: associated nausea, vomiting, dyspnoea, dizziness, weakness PE: S4 gallop, holosystolic murmur (mitral regurgitation), bibasilar rales; hypotensive, tachycardic, bradycardia
Myocardial Infarction (STEMI, NSTEMI)
Fm Hx: Hypertension, hyperlipidemia S: associated nausea, vomiting, dyspnoea, dizziness, weakness, PE: S4 gallop, holosystolic murmur (mitral regurgitation), bibasilar rales; hypotensive, tachycardic, bradycardia
Stable Angina
S: pain only on exertion
Non-Ischemic
Others
Aortic Dissection
S: Tearing chest pain, radiates to the back PE: unequal pulses or BPs in both arms; new diastolic murmur due to aortic regurgitation
Pericarditis
S: Viral Syndrome, radiate to trap ridge, neck, shoulder, Sitting forward relieves pain PE: Friction rub on aus
Cardiac Tamponade
Hx: of heart diseases. Dizziness PE: Hypotension, JVP, pulsus paradoxus (a drop of ≥10 mmHg in arterial BP on inspiration)
Myocarditis
S: Palpitations, Fever, Fatigue, Dyspnea PE:
Valvular
Aortic Stenosis
S: Radiating back pain, SOB PE: Ejection Systolic Murmur, S2 Obliteration
Mitral Valve Prolapse
S: Asymptomatic PE: mid-systolic click and late systolic murmur at the apex
Respiratory
Pneumothorax
Hx: Trauma S: SOB PE: No breath sound, Hyper-resonant percussion, Tracheal Deviation
Pulmonary Embolism
Hx: Hx of orthopedic surgery, hypercoag state, immobilization, DVT S:SOB PE: Loud P2, S4 Gallop, Pedal Edema
Pneumonia
S: Productive or dry cough, fever, myalgia PE: Decreased breath, Dull Percussion, increased tactile fremitus
Acute Asthma/COPD
Hx: History of asthma S: SOB
Pleuritis
S: Cough,fever, dyspnea PE: Pleural Rub
Lung Cancer
GI
Esophagus/Upper Stomach
Peptic Ulcer Disease
Hx: NSAIDs use, chronic alcohol consumption PE: Epigastric Tenderness
GERD
S: burning sensation after eating fatty meal, worse on lying down
Esophageal Spasm/rupture
S: Dysphagia
Stomach, Intestine
Gastritis
Acute Cholecystitis
S: RUQ Pain to R shoulder PE: Murphy's sign (RUQ tenderdness)
Pancreatitis
Hx: history of alcohol use PE: Ecchymosis in periumbilical region (Cullen's sign)
Skin, Muscle
Costochondritis
S: Worse on coughing, twisting, physical activity PE: Tenderness over sternal edges
Cervical Spondylitis
Herpes Zoster
Other Musculoskeletal
S: Sharp chest pain, worse with movement and inspiration
Psychogenic
Jimin Suh TeamLEAD12 Team 6