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Chest discomfort - Coggle Diagram

- - - - irritable
      - fatigue
      - sleep problem
    - - personal history
      - PE
    - - stress
      - personality
      - trauma
      - drugs or alcohol
      - having blood relatives with anxiety disorder
      - other mental health disorder
    - - guided self-help
      - cognitive behavioral therapy
  - - - Burning feeling in the chest
      - Sour or bitter taste at the back of the mouth
      - Difficulty swallowing
      - Chronic cough
      - Asthma
    - - Lower esophageal sphincter defect
    - - Barium swallow
      - Upper endoscopy
      - Esophageal manometry
      - Esophageal pH monitoring
    - - Make change to eating habits
      - Antacids
      - H2 receptor blockers
      - Proton pump inhibitors
  - - - muscle spasms
      - stiffness
      - soreness
      - swelling
      - bruising
    - - X-ray
    - - muscle fatigue
      - muscle tightness
      - old age or adolescence
      - muscle imbalance
    - - rest
      - ice
      - compression
      - Elevation
  - - - Chest pain when breathing or coughing
      - Confusion
      - Fatigue
      - Fever
      - Lower body temperature
      - Nausea, vomiting, or diarrhea
      - Shortness of breath
    - - Blood test
      - Chest x-ray or CT
      - Pulse oximetry
      - Sputum test
      - Pleural fluid culture
    - - Children or elder people
      - Being hospitalized
      - Chronic pulmonary or cardiac diseases
      - Weakened of suppressed immune system
    - - Antibiotics
      - Cough medicine
      - Fever and pain relievers
      - Hospitalization
  - - - Heartburn from GERD
      - Tightness
      - Most people don't have any symptoms
      - Bloating
      - Burping
      - Bad taste in mouth
    - - Born with a larger hiatal opening
      - Most patient have unclear causes
      - Injury
      - Rise pressure in belly, ass from pregnancy, obesity,
        coughing, etc.
    - - Barium swallow
      - Endoscopy
    - - Do nothing or symptom treatment
      - Surgery
  - - - More Painful when breathing, bend or
        twist body pressed on,
      - Tightness
    - - Osteoporosis
      - Sports
      - Cancer
    - - CXR
    - - Rest and take medicine for pain relief if needed
  - - - Itching
      - Sensitivity to touch
      - Tightness
      - Tingling, burning
      - Fatigue and headache
      - Fever
    - - Older than 50
      - Patients with HIV and cancer
      - Undergoing cancer treatments
      - Taking certain medications
      - Contagious
    - - Dermatomal pattern
      - Tzanck smear
      - IgM antibody
    - - Analgesics, steroids and other symptomatic treatment
      - Antivirals
      - acyclovir, valacyclovir
  - - - Pain radiate to back
      - Pain eased by leaning forward
      - Sudden severe upper abdominal pain
    - - Choledocholithiasis
      - Alcohol consumption
      - Heavy meal
      - Infection
      - Autoimmune disease
      - Post-ERCP
    - - Grey-Turner sign
      - Cullen sign
      - Elevated amylase and lipase
      - Radiology
    - - Fluid balance
      - Atropine
      - H2 antagonist
      - Proton pump inhibitor (PPI)
      - Growth hormone release inhibiting hormone (GHRIH)
      - Somatostatin
      - Aprotinin
  - - - Fatigue
      - Cyanosis
      - Dyspnea
      - Heart palpitation
      - Dizziness
    - - Right heart catheterization
      - Pulmonary function tests and arterial blood gases
      - Cardiopulmonary exercise testing
      - EKG
      - Blood tests and immunology
      - Transthoracic echocardiography
      - Ventilation/perfusion lung scanning
      - CT
    - - Scleroderma
      - Liver cirrhosis
      - Taking methamphetamines
      - Failure of left ventricle
      - Congenital heart disease
      - Aortic/mitral valve diseases
      - COPD
      - Pulmonary fibrosis
    - - Anticoagulant medicines
      - Diuretics
      - Oxygen treatment
      - Vasodilators
      - Guanylate cyclase (GSC) stimulators
      - Endothelin receptor antagonists
      - Digoxin
  - - - clay-colored stool
      - stomach pain
      - dark urine
      - diarrhea
      - nausea/vomitting
      - indigestion
    - - CT scan
      - Chlangiography
      - ultrasound scan
      - MRI
    - - having cirrhosis
      - female
      - overweight
      - pregnant
      - DM
      - familial history
      - female
    - - drainage tube
      - Surgery
      - healthy lifestyle
  - - - arthritis
      - physical strain
      - injury
      - tietze syndrome
      - tumors
    - - MRI
      - CT
      - x-ray
    - - sharp, aching or pressure-like pain
      - occur on the left side of breastbone
    - - non-steroidal anti-inflammatory drug
      - narcotics
      - anti-seizure drug
      - antidepressants
      - stretching exercise
      - transcutaneous electrical nerve stimulation
  - - - pressure or tightness in the chest
      - nausea
      - sweating
      - vomitting
      - anxiety
      - fast heart rate
    - - EKG
      - Angiogram
      - blood test
    - - smoking
      - smoking
      - high blood pressure
      - DM
      - obesity
      - lack of exercise
      - high blood cholesterol
      - poor diet
      - excessive alcohol
      - excessive alcohol intake
    - - coronary artery bypass graft(CABG)
      - Blood thinners (such as aspirin)
      - angioplasty
      - antiplatelet drug
      - pain relievers
      - beta-blocker
      - ACE inhibitor
  - - - Shortness of breath
      - Chest tightness of pain
      - Wheezing while exhaling
      - Trouble sleeping
    - - Lung function test
      - Methacholine challenge
      - Imaging tests
      - Allergy test
      - Nitric oxide test
    - - Family history
      - Obesity
      - Smoking or exposure to secondhand smoke
      - Occupational triggers
    - - Inhaled corticosteroids
      - Short-acting β2 agonist for quick relief
- - - - Esophageal manometry
      - X-ray of upper digestive system
      - Upper endoscopy
    - - GERD
      - Hypertension
      - Anxiety or depression
      - Very hot or cold drinks and food
    - - Squeezing pain in the chest, might mistake it for angina
      - Difficulty swallowing
      - The feeling that an object is stuck in the throat
      - GERD
    - - Avoid extremely hot or cold food
      - Manage underlying conditions
      - Medications to relax swallowing muscles
      - Surgery（myotomy）
  - - - Difficulty swallowing
      - A lump in throat
      - Chronic cough
      - Disrupted sleep
      - Laryngitis
      - Burning pain
        
        Case3
      - Worsening when lying flat
        
        Case3
    - - Obesity
        
        Case3
      - Hiatal hernia
      - Pregnancy
      - Smoking
      - Eating fatty of fried food
      - Coffee or alcohol consuming
        
        Case3
      - Eating sweet food
        
        Case3
      - DM
        
        Case3
    - - Upper endoscopy
      - Ambulatory acid probe test
      - Esophageal manometry
      - X ray
  - - - Taking NSAIDs
      - Helicobacter pylori infection
      - Smoking
      - Alcohol consumption
      - Zollinger-Ellison syndrome
    - - Epigastric pain that radiate to chest
      - Acidic vomitus
      - Feeling of fullness, bloating or belching
      - Intolerance to fatty foods
      - Heartburn
      - Tarry stools
    - - Looking for H. pylori using blood, stool or breath test.
      - Detecting ulcer or biopsy by endoscopy
      - Upper gastrointestinal series (UGI)
    - - Acid blocker (histamine blocker/H2 blocker)
      - Antacids neutralizing stomach acid
      - Proton pump inhibitors (PPI)
      - Cytoprotective agents
      - Antibiotics killing H. pylori
- - - - sharp, aching or pressure-like pain
      - occur on the left side of breastbone
    - - injury
      - physical strain
      - arthritis
      - tumors
      - tietze syndrome
    - - X-ray
      - CT
      - MRI
    - - non-steroidal anti-inflammatory drugs
      - narcotics
      - antidepressants
      - anti-seizure drug
      - stretching exercise
      - transcutaneous electrical nerve stimulation
  - - - ultrasound
      - HIDA scan
      - chest& abdominal X-ray
      - endoscopic retrograde cholangiopancreatography(ERCP)
      - Murphy's sign
    - - surgery
    - - nausea/vomiting
      - fever/chills
      - mid-to-upper-right pain
      - chronic diarrhea
      - jaundice
      - dark urine
      - lighter-colored
    - - gallbladder cancer
      - gallstones
      - binary dyskinesia
      - cholecystitis
      - female
      - older than 40
      - pregnancy
      - obesity
- - - - 撕裂痛
        
        Case2
      - 刺痛
      - 前胸痛
        
        Case2
      - 呼吸急促
      - 後背痛
        
        Case2
      - 腿軟
    - - 高血壓
        
        case2
      - Marfan syndrome
        
        case2
      - 二尖瓣缺陷
      - 動脈硬化
      - Cocaine use
      - Turner's syndrome
    - - Transesophageal echocardiogram
      - CT
      - Magnetic resonance angiogram
      - D-dimer less than 500 ng/ml可以排除
      - Chest X-ray
    - - A type
        
        surgery
      - B type
        
        Beta blockers
        
        Calcium channel blockers
        
        verapamil
        
        diltiazem
- - - - Exacerbate while lying down and breathing
    - - Friction rub
      - 若有pericardium effusion會覺得心音較遠
      - Extensive ST elevation and PR depression, T wave inversion and Spotdick's sign on EKG
    - - Viral, bacterial, or fungal infection
      - Recovery from a heart attack
      - Autoimmune disease
      - Kidney failure
    - - NSAIDs
      - Steroid
      - Colchicine
- - - - Dyslipidemia
        
        Case 1
      - DM
        
        Case 1
      - Alcohol consumption
      - Hypertension
      - Physical inactivity
      - Obesity
      - Smoking
        
        Case 1
      - Cold temperature
      - Atherosclerosis
      - Emotional stress
      - Unstable angina: plaque rupture
    - - Unstable angina: 即使休息也無法緩解
        
        Case 1
      - Myocardial infarction: Typical chest pain > 30 minutes
      - Stable angina: 運動或緊張時疼痛，休息時緩解
        
        Case 1
      - 冒冷汗
        
        Case 1
    - - CK-MB > 6.3 ng/ml
      - Exercise electrocardiography, stress test
      - Troponin-I > 0.04 ng/ml
      - Tl-201 Heart perfusion scan
      - ST elevation 2 mm in at least 2 consecutive precordial leads
      - CT angiography
      - ST elevation 1 mm at least 2 consecutive limb leads
        
        Case 1
      - Cardiac magnetic resonance (CMR)
      - 聽到S4心音
      - Holter's 24 hour ECG
      - ST segment depression with normal cardiac enzyme: Stable angina or unstable angina without infarction
      - ST segment depression with elevated cardiac enzyme: NSTEMI
    - - Atherectomy or endarterectomy
      - Antithrombotic or antiplatelet agent
      - Coronary artery bypass grafting
      - Thrombolytic agent
      - Angioplasty (Percutaneous coronary intervention, PCI or Stenting)
        
        Case 1
      - Lipid lowering agents (HMG CoA reductase)
      - Ca channel blocker
      - Drugs for remodeling modification
      - Beta blockers
      - Nitrates