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Chest discomfort, Case3, aortic emergency - Coggle Diagram

- - - - symptom
        
        heartburn
        
        relieving factor:坐姿，exaggerating:躺
        
        to relieve
        
        gastric acid reflux
        
        dysphagia
        
        acid regurgitation
        
        chronic cough
        
        hoarseness, Sore throat
      - risk factor
        
        obesity
        
        associate to
        
        hyperlipidemia,Diabetes
        
        central nervous system depressants
        
        pregnancy
        
        alcohol and tobacco use
        
        hiatal hernia
        
        delayed gastric emptying
        
        associate to
        
        inappropriate diet
        
        increased gastric volume
      - pathophysiology
        
        increased abdominal pressure
        
        associate to
        
        obesity
        
        decreased lower esophageal sphincter(LES) tone
        
        associate to
        
        Food:Fat, chocolate(theobromine containing) ,peppermint, caffeine containing(tea, coffee)
        
        Drug:beta-adrenergic agonist, cholinergic antagonist(ex. drug for asthma,COPD)
      - Diagnosis
        
        endoscopic presentation
        
        esophageal stricture
        
        Barrett's esophagus
        
        esophageal adenocarcinoma
        
        erosive esophagitis
        
        Proton Pump Inhibitor(PPI test)
        
        if effective
        
        continue treatment
        
        if not effective
        
        us 24-Hr pH Study to confirm GERD
    - - symptom
        
        retrosternal chest and upper abdominal pain
        
        Odynophagia, tachypnea, dyspnea, cyanosis, fever, and shock
        
        Subcutaneous emphysema(not sensitive)
        
        pleural effusion
        
        Mackler's triad( chest pain, vomiting, and subcutaneous emphysema)
        
        pain radiate to the left shoulder
      - diagnosis
        
        chest CT scan(to conform)
        
        chest radiography(free air appear
    - - trigger
        
        cold/hot food
      - cause
        
        可能是自主神經異常
      - symptom
        
        chest pain that may spread outward to the arms, back, neck, or jaw.
        
        similar to heart attack
        
        difficulty or inability to swallow food or liquid
        
        pain with swallowing
        
        burning sensation in the chest
      - diagnosis
        
        esophagus tests( esophageal manometry)
        
        barium swallow+X-ray
    - - cause
        
        H. pylori
        
        anti-inflammatory drugs(aspirin...)
        
        smoking
        
        alcohol
        
        stomach cance
      - symptom
        
        nausea
        
        dark stools
        
        unexplained weight loss
        
        indigestion
        
        vomiting
        
        chest pain
      - diagnosis
        
        Upper endoscopy
        
        barium swallow
  - - - 頸椎神經根炎
        
        C3-C5壓迫
      - Marfan syndrome
        
        pathology
        
        FBN1 gene mutation
        
        fibrin-1蛋白質病變
        
        diagnosis
        
        revised Ghent nosology
        
        長相奇特
        
        aortic root aneurysm
        
        eye lens dislocation
        
        family history of definite Marfan syndrome
        
        examination
        
        complete skeletal examination
        
        molecular testing
        
        echocardiogram
        
        slit-lamp eye examination
      - 肋軟骨腫大
        
        無
        
        肋軟骨炎
        
        有
        
        Tietze syndrome
    - - exertional pain
      - radiation to the neck or arms
      - numbness
      - pain localized to atypical areas (eg. axilla or midthoracic spine)
  - - - stabbing pressure
      - unusual muscle twitch or spasm in chest
      - sharp, shooting pain
      - persistent chest aching
      - burning, numbness, or a dull ache
      - chest tension or tightness
    - - anxious
      - pressure
- - - - demand太多
      - 血液supply不夠
    - - chest pressure
        
        在rest時
        
        沒有relieved
        
        CAD
        
        ACS
        
        EKG 診斷
        
        1 more item...
        
        physical finding
        
        4 more items...
        
        有relieved
        
        stable angina
        
        pericarditis
        
        姿勢改變而疼痛加重or緩解
        
        EKG：PR depression
        
        sharp pain
        
        diffuse ST elevation
        
        pericardial friction rub
      - dyspena
      - 恐慌感
      - Angina pectoris
      - pain
        
        burning
        
        gastrointestinal disease
        
        sharp、tearing
        
        pericardial、aortic disease
        
        oppressive, squeeze
        
        ACS
    - - Aging
        
        男>45；女>55
      - Cigarette smoking
      - Obesity or overweight
      - High blood pressure
      - Hyperlipidemia
        
        LDL, TG ,Cholesterol上升；HDL下降
      - hyperglycemia
        
        Diabetes
    - - CK-MB (0.6~6.3 ng/mL)
        
        myocardial infraction
        
        angina
        
        Myocarditis
      - Troponin (<0.04 ng/ml)
        
        急性心肌梗塞 (AMI)
        
        高於
        
        NSTEMI
        
        低於
        
        early myocardial injury
      - D-dimer (<0.4 mg/L)
        
        pulmonary embolism
      - BNP
        
        heart failure
  - - - cause
        
        unilateral edema
        
        DVT
      - laboratory diagnosis
        
        D-dimer
        
        arterial blood test
        
        Westermark sign
      - PE
        
        shallow, fast breath
        
        platypnea
    - - pathology
        
        pressure overload
        
        ventricular hypertrophy
      - PE
        
        splitting of S2
        
        systolic pulmonary ejection click
      - laboratory diagnosis
        
        diffusion capacity reduced
        
        elevated pulmonary artery pressure
- - - - Ripping or tearing
      - Radiation from ant. chest to mid-back
    - - Hypertension；Hyperlipidemia
      - Marfan syndrome
      - Smoking
    - - Tear of intima
        
        False lumen
      - Elastic or muscular components deterioration
        
        EX
        
        Pregnancy
        
        Marfan syndrome
        
        E-D syndrome
        
        Bicuspid aortic disease
    - - Transesophageal echocardiography(TEE)
      - CT Scan
        
        False lumen
      - Magnetic resonance angiogram (MRA)
      - CXR
        
        Widening of the aorta
    - - smooth muscle myosin heavy chain protein
      - Soluble elastin fragments
      - metalloproteinase-9
    - - Ausculation
        
        systolic & dystolic murmur around aorta
      - Vital sign
        
        asymmetric BP and pulse between two upper extremities
  - - - Penetrating ulcer
      - Rupture of vasa vasorum
  - - - Ulcer of atheromatous plaque
      - Extend to adventitia
    - - CT scan
        
        Thickened aortic wall in absence of an intimal flap or a false lumen
      - TEE
      - MRA or MRI