Chest pain knowledge for medical students and physicians. Figure 1 110104 pa and lateral radiographs of the chest showing acute chest. Pain is a common health condition, and is usually temporary in nature. Jan 25, 2009 i have squeezing, gripping pain in my chest left side when i get to a certain intensity in exercising. It is the presenting complaint in 1% of clinicbased visits. I have squeezing, gripping pain in my chest left side when. We report the case of a hodgkins lymphoma presenting as chest pain due to the presence of multiple lymphoade nopathies of the superior mediastinum and a polylobated mass in the middle lobe of the right lung. One in four persons with a panic attack will have chest pain and shortness of breath. Last weekend i had one of these episodes while on the treadmill. The pain gradually goes away when i stop excercising. The differential diagnosis of chest pain sciencedirect.
Approach to undifferentiated chest pain in the emergency. Nov 01, 2004 his chest xray showed a left lower lobe infiltrate. Differential dx strategies university of massachusetts. Glial cell linederived neurotrophic factor gdnf is a neurotrophic factor for a subset of nociceptive dorsal root ganglion drg neurons and plays critical roles in their survival, neurite outgrowth, and synaptic function. Value and limitations of chest pain history in the.
Chest pain is a commonly presenting complaint in general practice, and conditions causing chest pain or discomfort such as acute coronary syndrome or angina have a potentially poor prognosis. Chest pain differential diagnosis productive medic. Differential diagnosis for chest pain oxford medical. Furthermore, within the consideration of lifethreatening causes, patients may be suffering from coronary causes, as well as pulmonary embolism, aortic dissection, aortic rupture, pneumothorax, or even esophageal rupture. Assessment of chest pain differential diagnosis of. Typical chest pain with normal ecg human health campus. Mrcgp csa exam standard csa case about chest pain practice. It is the presenting complaint in 1% of officebased visits.
Chest pain that radiates to the back, jaw, left arm or left shoulder. Diagnosing the cause of chest pain american family physician. The typicality of chest pain can be categorised as follows. Pdf what is the most reliable marker in the differential. Chest pain presents a diagnostic challenge in outpatient family. The differential is expressed in terms of the discount factor df.
It is a serious concern for patients and practitioners. Common and important causes of chest pain for doctors and medical students. Ideally, the detailed history is taken where resuscitation facilities are available. Cause grouping differentials classical history classic examination findings investigation findings initial test, diagnostic test.
Differential diagnosis for chest pain oxford medical education. Dr ponka is an assistant professor and dr kirlew is a secondyear resident in the department of family medicine at the university of ottawa in ontario. Of all patients presenting to primary care with chest pain 12% of all consultations, around 15% are thought to be nonspecific i. Once the clinical examination has narrowed the differential diagnosis. These are mock csa cases written by recently qualified gps who have attended and successfully navigated through the csa exams. Chest pain may be caused by either benign or lifethreatening etiologies and is usually divided into cardiac. Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the us per year. The younger the patient, the more likely an organic etiology will be found although there is. Chest pain differential diagnosis free questions and answers for doctors and medical student exams. Chest pain cardiac or not treat patient as though he is critical until proved otherwise history risk factors, ho ihd, previous rxs, previous chest pain pain heart burn burning. Diseases involving the chest or thorax can manifest themselves as chest pain or discomfort, shortness of breath sob, pressure or squeezing around the chest, cough or indigestion. Chest pain is a common pediatric complaint with the average presenting age of 12. Mrcgp exam csa case course courses chest pain thrombosis vein.
All of these are highrisk symptoms so you have to be really careful because your patient is more likely to suffer a heart attack. The main aim of this study was to examine the association between these subgroups, their baseline. Tumors of the chest wall are varied, some of which are found most often in this region. Assessment of chest pain differential diagnosis of symptoms. In a secondary care setting, differences between neck pain. Chest pain pediatrics clerkship the university of chicago. A clinical diagnosis of acute chest syndrome was made. In the uk, 1% to 2% of adults attend primary care each year with a new presentation of chest pain. The differential diagnosis of chest pain syndrome is broad and disparate, including disease processes that range from nonurgent to life threatening. It is much worse when inhaling as if i cant really take a deep breath. Beretta nuclear medicine service, asociacion espanola montevideo, uruguay.
Early, nonspecific ecg changes will suggest an acute. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. Traditional textbooks still assign pain localization a certain discriminative role in the differential diagnosis of chest pain. Pectus excavatum is accompanied in most patients by diminished static pulmonary function. Her ecg shows normal sinus rhythm, the initial serum troponin i is 32. Shortness of breath hypotension, tracheal deviation and neck vein distention tachycardia tachypnea cough fatigue cyanosis diagnosis. Overexpression of gdnf in the uninjured drg exerts analgesic. Evaluation of chest pain differential diagnosis of. In rosens emergency medicine concepts and clinical practice 8th ed.
The differential diagnosis of chest pain request pdf. Full text is available as a scanned copy of the original print version. Examination reveals a circular 4x4cm fullthickness burn to the midchest with surrounding deep and superficial partialthickness burns. Chest pain is the presenting complaint in over 6 million emergency department visits each year. In an intuitive process of probabilistic reasoning gps combine the initial. To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the follow us buttons. The higher the lr is above 1, the better it rules in disease greater than 10 is considered good. Nontraumatic chest pain is one of the most common causes of emergency department visits and is common in both inpatients and outpatients. Differential diagnosis for productive cough oxford medical. Differentiating acute coronary syndrome acs from other, noncardiac causes of chest pain is imperative in emergency practice. History of exertional chest pain or exertional syncope.
This refers to chest pain that is not sharp and is not the patients familiar angina. Chest pain is unusual presentation of dka, however, acute coronary. Decreased or absent breath sounds over the affected lung. Acute chest or back pain and a pulse differential in the upper extremities 5. She transiently lost consciousness but was awake upon ems arrival. The differential diagnosis is broad and includes cardiac e. Diagnostic ap proach and differential diagnosis are discussed.
They can be divided into benign and malignant tumors and into those which arise in the ribcage and those of soft tissue density. Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Chest pain david ponka, md and michael kirlew, md dr ponka is an assistant professor and dr kirlew is a secondyear resident in the department of family medicine at the university of ottawa in ontario. However, when we speak of chest pain, the reason behind the same need not be something temporary. With symptoms this complex, you owe it to yourself to call your doctor to help you make sense out of them. In other situations where immediate admission may not be indicated, a full. Chest pain murtaghs general practice, 7e murtagh collection. Chest pain is something that cannot be neglected under any circumstances whatsoever. Request pdf the differential diagnosis of chest pain chest pain is a frequent complaint of patients seeking urgent medical assistance. He was counseled about his increased risk of complications with tobacco smoking.
Common and important causes of productive cough for doctors and medical students this page is currently being written and will be available soon. Chest pain differential diagnosis linkedin slideshare. Most patients with chest pain are initially seen by their general practitioner gp who. The patient is status post left sided central line placement with interval development of shortness of breath. Differential diagnosis of acute chest pain oscestop. Get a printable copy pdf file of the complete article 1. The main differential diagnoses of acs include aortic dissection, pericarditis, oesophageal reflux and spasm, biliary colic and hyperventilation with anxiety. Doctors give trusted, helpful answers on causes, diagnosis, symptoms, treatment, and more. Sudden onset of chest pain that is sharp in nature and may lead to feelings of tightness in the chest. The frequency of pediatric chest pain among different eds has been shown to be anywhere between 0. Depending upon the cause, chest pain can have varying qualities sharp, dull, burning, can be located in one or several areas middle of the chest, upper or left chest, back, arms, jaw, neck, or the. Correction by nuss procedure results in improvement in chest wall motion.
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