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78-year-old female (Crushing central chest pain for 20 mins (Respiratory…

- - - - Panic disorder
      - Hyperventilation syndrome
    - - Depression
    - - Delusions
  - - - Infectious
        
        Pneumonia
        
        fever, productive cough, dullness to percussion, bronchial breath sounds
        
        Tuberculosis
        
        Night sweats, hemoptysis, lymphadenopathy, dullness, bronchial breath sounds, crepitations
      - Inflammatory
        
        Pleuritis
      - Pulmonary embolism
        
        dyspnea, cough, hemoptysis, unilateral leg edema
      - Pneumothorax
        
        Lateral aspect of chest wall. radiate to neck & back. Tracheal deviation. Decreased breath sounds
    - - Dyspnea & Wheezing
        
        COPD
        
        Asthma
        
        Cough worse at night
    - - cough, hemoptysis, dyspnea
    - - Dyspnea, cough
    - - dyspnea, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema, palpitations
  - - - Chest wall pain
        
        Isolated musculoskeletal chest pain syndromes
        
        Costochondritis
        
        dull and exacerbated by movement, palpation, and inspiration
        
        lower rib pain syndromes
        
        Rheumatic diseases
    - - Pleuritic chest pain
  - - - Angina mimic
        
        GERD
        
        Epigastric discomfort, retrosternal burn, non-exertional, present at rest, onset when supine (cough), unaffected by respiration. dysphagia
        
        can present with
        
        Esophageal pain
        
        persistent pain >1 hour, postprandial pain, lack of radiation, heartburn or regurgitation
      - Esophagitis
        
        dysphagia or dyspepsia
      - Mimic GERD
        
        Eosinophilic esophagitis
        
        Atopy increases risk
      - straining/vomiting
        
        Spontaneous rupture
        
        Boerhaave syndrome
    - - Peptic ulcer disease
        
        Epigastric discomfort, retrosternal burn
        
        Gastric
        
        worsens with food intake
        
        Duodenal
        
        alleviated with food intake
    - - Severe epigastric pain radiates most commonly to the back, associated with nausea and vomiting. Tenderness
    - - sharp RUQ pain that radiates to the right shoulder, or less commonly, retrosternally
        
        Biliary colic
        
        Cholangitis
        
        Fever, jaundice
        
        Choledocholithiasis
        
        Nausea, vomit
        
        Cholecystitis
        
        Following fatty food ingestion, Often at night. Positive murphy's sign: Arrest in inspiration while palpating the gallbladder during a deep breath. Fever.
  - - - New. Onset at rest, severe pain, last longer
        
        Acute coronary syndrome
        
        Acute Myocardial infarction
        
        More likely if pain radiate to BOTH arms, hypotension, S3 gallop
        
        Unstable Angina
        
        substernal pain ≥ 10 minutes (MI longer). Radiation: neck, jaw, shoulder, left arm. worse with exertion. not (MI) reliefed by rest (angina). dyspnea, nausea, vomiting, diaphoresis, lightheadedness, palpitations, abdominal pain. elevated JVP, S3, S4, MR
      - Onset on exertion, brief
        
        Myocardial Ischemia
        
        Angina pectoris
        
        Typical/Stable
        
        Substernal chest discomfort
        
        Triggered by exertion and emotional stress.
        
        Relieved by rest or nitrate
        
        Nonanginal
        
        Atypical
        
        2/3
        
        can lead to
    - - pleuritic chest pain (sharp&stabbing), at rest, worse supine
        
        Myocarditis
        
        dyspnea, tachycardia
        
        Pericarditis
        
        Can progress to
        
        Cardiac tamponade
        
        Hypotension, tachypneic, dullnes, bronchial breathing, elevated JVP
      - Heart failure
        
        fatigue, exertional dyspnea, orthopnea, edema
      - Aortic aneurysm dissection
        
        acute restrosternal radiates to back. severe, sharp, and may have a ripping or tearing quality
      - precipitated by acute emotional or physiologic stress.
        
        Stress cardiomyopathy
        
        Dyspnea, palpitations
      - Valvular disease
        
        Mitral stenosis
        
        exertional dyspnea, hemoptysis, wheezing, orthopnea, edema, tachycardia, heart murmur