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Chest pain (Terms (Non cardiac chest pain (Chest pain that meets 1 or none…

- - - - Duration
        
        2-20mins
        
        Angina pectoris(Stable angina), Esophageal disease, MS or Pscyho
        
        <15 s
        
        Non cardiac pain,MS or psycho pain, Hiatal hernia(stomach hernia and remains in chest cavity)
        
        Prolonged >20min
        
        UA/MI, Esophageal disease,Pulmonary disorders,Pericarditis, Aortic dissection, MS disease, Herpes zoster,Acute GI
      - Radiation
        
        Lower jaw, neck or teeth
        
        MI
        
        One or both arms
        
        MI, Pericarditis, Cervical spine disease(neck pain), Cholecystitis(right shoulder)
        
        Interscapular region or back
        
        Aortic dissection, Thoracic aortic aneurysms, Pericarditis, Esophageal disease,Pancreatitis, Peptic ulcer,MI
        
        Epigastrium
        
        Esophageal disease, pancreatitis, Peptic ulcer, Biliary tract disease,MI
      - Location
        
        Diffuse, poorly localised, retrosternal
        
        MI, PE
        
        Over skin/superficial structures such as costochondral joints and reproduced by palpation
        
        MS Pain, Costochondritis, chest wall syndrome
        
        Localised <3cm at area of left nipple(circumscribed by one finger)
        
        Non cardiac pain (MS, Psycho, gaseous distension of stomach)
      - Quality
        
        Pressure, strangling,burning, squeezing?
        
        Myocardial Ischemia
        
        Deep, heavy aching (visceral) pain
        
        Herpes Zoster can present as tight band across chest
        
        Tightness or heaviness
        
        Esophageal reflux/spasm
        
        Pulmonary hypertension (with right ventricular ischemia )can present with chest pressure
        
        Indigestion, nausea
        
        MI, Esophageal disease, peptic ulcer
        
        Severe tearing, ripping pain
        
        Aortic dissection
        
        Sharp and stabbing
        
        Pericarditis, Pleuritis,PE, Pneumothorax,Muscoloskeletal pain, psychogenic pain
        
        Dull, persistent pain lasting hours or days localised (<3cm) to cardiac apex (inflammatory area)
        
        Psychogenic pain
      - Precipitating
        
        Exertion (classically in the cold or against wind after a heavy meal
        
        Angina Pectoris
        
        Emotional stress
        
        Angina pectoris
        
        Eating meals
        
        Esophageal pain, Peptic ulcer, Angina pectoris
        
        Lying down or bending after meals
        
        Esophageal reflux
        
        Bending or moving the neck
        
        Cervical/Upper thoracic spine disease
        
        Respiration or cough
        
        PE, Pneumothorax, Pericarditis,Pleuritis, MS pain
        
        Positional pain
        
        Pericarditis, pancreatitis
      - Relieving
        
        Sitting up and leaning forward
        
        Pancreatitis, Pericarditis
        
        Antacids or food
        
        Esophagitis, peptic ulcer
        
        Rest or sublingual GTN(usually within minutes)
        
        Angina pectoris, esophageal spasm
        
        Holding the breath at deep expirations
        
        Pleuritis
      - Associated symptoms
      - AS
        
        Acid reflux: Esophageal reflux
        
        Hemoptysis: PE, Pneumonia
        
        Fever: Pneumonia, pericarditis, pleuritis
        
        Syncope: MI,Massive PE,Aortic stenosis,arrthymia
        
        Dyspnea:MI,PE,Pneumothorax, pneumonia
        
        Diaphoresis:MI,PE, Aortic dissection
        
        Nausea and vomiting: MI,Acute GI pathology
  - - - Chest pain with syncope
      - Chest pain with hemoptysis
        
        DDx; Pneumonia (But got fever), Tracheobronchitis
      - Chest pain with acute dyspnea
      - Diaphoresis
    - - Chest pain with acute dyspnea
    - - Severe persistent migrating chest and back pain
        
        Can consider DDx: Aortic aneurysms, Pericarditis, Pancreatitis, Peptic ulcer
      - Sudden onset of severe "tearing"or "ripping"chest pain
      - History of Marfan
      - Diaphoresis
      - Exclude Not sudden onset
    - - Chest pain with fever
        
        DDx: Acute GI Pathology
    - - UA
        
        Chest pain radiating to both arms/Either arm
        
        Diaphoresis
        
        New onset or acceleration of chest pain (to CCS 3), typical or atypical with high CAD probability
        
        DDx:Esophageal disease, Musculoskeletal chestpain, Nonischemic chest pain,Psychogenic chest pain
      - Stable angina and other cardiac disease
      - MI
        
        Chest pain with palpitation
        
        Ddx: Tachyarrhythmias
        
        Chest pain with syncope(hypotension)
        
        DDx:P.E, Arrythmias, Pericardial tamponade, vasovagal syncope
        
        Sudden onset chest pain with acute dyspnea
        
        DDx: PE,Spontaneous pneumothorax, Pleuritis, Musculoskeletal chest pain
        
        Chest pain radiating to both arms
        
        DDx: UA, Pericarditis, Cervical spine disordesr
        
        Chest pain radiating to right arm/shoulder
        
        DDx: UA, Biliary colic, Pericarditis, Cervical spine disorders
        
        Chest pain radiating to left arm/shoulder
        
        DDx:UA, Pericarditis, Cervical spine disorders
        
        Burning chest pain
        
        DDx: MI, UA,(Got radiation to arm) Gastroesophageal disease
        
        Chest pain with diaphoresis
        
        DDx: MI(radiate to arm), UA(radiate to arm),PE,Aortic dissection(radiate to back)
        
        Chest pain with prior history of MI
        
        DDx: MI, UA, Nonischemic causes
        
        Typical angina that is prolonged or occurs at rest or atypical angina with the same symptoms and high CAD probability
        
        DDx: Esophageal disease, Musculoskeletal chest pain, Nonischemic chest pain,Psychogenic chest pain
        
        How to exclude: Pleuritc chest pain, Chest pain reproduced by palpation, Sharp or stabbing pain, Positional chest pain
    - - Chest pain with fever
        
        DDx: Pneumonia
      - Chest pain with nausea/vomiting
    - - Vs Hematemesis
        
        Nausea/Upset stomach vs Tingling sensation in throat
        
        Dark red/Non- Frothy plus food particles vs bright red frothy
        
        If test is acidic vs alkaline for hemoptysis
      - PE, Tracheobronchitis
    - - MI, PE,Spontaneous pneumothorax, Pleuritis, Musculoskeletal chest pain
    - - MI, PE, Arrythmias, Pericardial tamponade, vasovagal syncope
    - - MI(radiate to arm), UA(radiate to arm),PE,Aortic dissection(radiate to back)
    - - DDx: Aortic dissection, Aortic aneurysms, Pericarditis, Pancreatitis, Peptic ulcer
    - - MI, UA, Cervical spine disorder, pericarditis
    - - MI, Tachyarrhythmia
- - - - Pneumothorax
      - Pneumonia
      - Pulmonary embolism (PE)
      - Pleuritis
    - - Sternoclavicular arthritis
      - Costochondritis
        
        Costochondritis is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone, or sternum. The condition causes localized chest pain that you can reproduce by pushing on the cartilage in the front of your ribcage. Costochondritis is a relatively harmless condition and usually goes away without treatment.
      - Cervical spine disorders
      - Herpes zoster
    - - Biliary disease (cholecystitis, choledocholithiasis)
      - Peptic ulcer
      - Esophageal (spams, reflux, esophagitis)
      - Pancreatitis
    - - Depression
      - Somatoform disorders
      - Anxiety disorders (hyperventilation, panic attacks)
      - Secondary gain
  - - - ACS (UA,MI)
      - Hypertrophic cardiomyopathy
      - Coronary artery spasm
      - Dilated cardiomyopathy
      - Coronary atherosclerosis/Coronary artery Disease
      - Tachycardia (Ventricular/Supraventricular)
      - Aortic stenosis
      - Sympathomimetic toxicity (eg cocaine)
      - Severe pulmonary hypertension
      - Sever hypertension
      - Severe anemia, hypoxia, hyperviscosity
      - Hyperthyroidism, hyperthermia
    - - Aortic Dissection
      - Pericarditis
      - Mitral valve prolapse