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chest discomfort, Ischemic Heart Disease, GERD（Reflux esophagitis）, acute…

- - - - Rule-out：serial troponin testing, high-sensitivity troponin assays正常
      - Clinical presentation：retrosternal, tightness, pressure，
        輻射到脖子、下巴、肩膀、手；
        服用NTG可緩解、運動加劇。
        Examination：ECG(ST elevation, Hyperacute T wave, QS pattern with ST elevation, T wave inversion)、
        心肌酵素上升(CK, CK-MB, Troponin I)
  - - - Clinical presentation：pleuritic pain
        relieved by bending forward
        PE：friction rub
        Examination：ECG(PR depression, ST elevation)、心包膜積水(CXR、心臟超音波)
  - - - Examination: 心導管、左心室攝影、
        ECG(ST-segment elevation)、心肌酵素上升
        排除AMI可能
  - - - History taking：發病前GI、呼吸道感染
        Examination：血液檢查(WBC, RBC,心肌酵素)ECG, CXR, echocardiography, coronary angiography, endomyocardial biopsy、病毒學檢查(+)
      - Rule-out：心臟磁共振成像CMRI正常
  - - - Clinical presentaion：dyspnea, orthopnea, paroxymal nocturnal dyspnea, Cheye-stokes respiration, cardiac asthma
        PE：lower limb edema, tachycardia, Cardiomegaly
        Examination：elevated BNP, ECG, cardiomegaly(CXR)
      - Rule-out：不滿足Framingham criteria
- - - - Clinical presentation:
        burning(火燒心)；飯後惡化，躺著惡化(睡眠問題)，坐起緩解；服用制酸劑可緩解。
        Examination:
        上消化道鋇劑攝影、24小時食道酸鹼值測定、胃鏡檢查。
  - - - Clinical presentation:
        squeezing(需與心絞痛區別)；吞嚥困難、吞嚥疼痛；服用NTG可緩解。
        Examination:
        鋇劑食道攝影、食道括約肌測壓檢查。
  - - - Clinical presentation: 呼吸困難、劇痛、休克、皮下氣腫。
        Examination: CXR(肋膜腔積水或氣體)、CT、內視鏡。
  - - - Clinical presentation: burning；飯後惡化、噁心、脹氣、血便。
        Examination: C-13吹氣檢驗、胃鏡。
  - - - Clinical presentation：colicky, aching；飯後，右上腹，輻射至背、右肩，持續數小時；噁心、嘔吐、發燒。
        Examination: Murphy's sign, 黃疸、茶色尿、WBC↑, GOT,GPT↑, 腹部超音波、XR、CT、MRI、ERCP。
- - - - Clinical presentation：sternal, localized pain；休息或側臥時緩解，呼吸或躺下時加重。
        Examination: CXR, CT
  - - - Clinical presentation：localized pain, numbness
        Examination: XR, CT, PE (頭轉動可能造成手部麻木)
  - - - Clinical presentation：localized pain
        Examination: XR, CT, PE
  - - - Clinical presentation：sharp, burning, dermatomal pain, vesicular rash, 發燒等病毒性症狀。
        Examination: Tzanck smear, PCR, 免疫螢光染色、病毒培養。
- - - - Clinical presentation：chest or upper back pain；tearing, sharp；sudden onset
        PE：脈膊不足、左右手收縮壓差異≧10 mmHg、低血壓≦90/60 mmHg
        Examination：CT
      - Rule out：D-Dimer陰性(< 500 μg/L)2
  - - - Clinical presentation：sharp pain；sudden-onset dyspnea；下肢腫脹
        Examination：ECG(sinus tachycardia, T波 ST段改變 S1Q3T3)；multiple slide CT、動脈血氧下降、D-dimer>500、肺動脈血管攝影
      - Rule-out：D-Dimer陰性、PERC(Pulmonary Embolism Rule-out Criteria)
  - - - Clinical presentation: fatigue, 運動容易喘、周邊水腫、頸靜脈怒張
        Examination：右心導管檢查、CXR、ECG顯示右心肥大、ECHO
- - - - Clinical presentation: 咳嗽、痰、呼吸困難、發燒
        PE：dullness、發燒、血液檢查感染、CXR
  - - - Clinical presentation: 突然且尖銳的胸痛、呼吸困難
        PE：hyperresonnace
        Examination：CXR
- - - - NSTEMI (transmural infarct)
      - STEMI(subendocardial infarct)
      - Unstable Angina
- - - - NSTEMI
    - - STEMI
- - - - acute pericarditis
      - acute pericardial tamponade (most common death of AD)
    - - hypertension
      - Marfan syndrome
      - trauma
      - pregnancy
      - atherosclerosis
    - - sudden onset
    - - Sudden severe pain, often described as a tearing, ripping or shearing sensation
    - - chest or upper back pain, sometimes radiates to the neck or down the back