Differential diagnosis of acute chest pain oscestop. Epidemiology of chest pain reflects selection bias. There are many other diagnoses that are much less time critical, but as. The differential diagnosis of chest pain syndrome is broad and disparate, including. Chest pain may be caused by either benign or lifethreatening etiologies and is. Aug 08, 20 we chose the chief complaint of chest pain as it is a common one with a wide variety of potential problems and diagnoses, and brings to bear elements of all aspects of medicine. Cpg chest pain en pdf american international health.
A man in his 70s presented to the ed with leftsided chest pain and shortness of breath. Coronary heart disease is the cause in up to 25% of cases. Nov 06, 2015 acute chest pain of nontraumatic origin is a common reason for presentation to physicians offices and emergency rooms. Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes. Strategies for generating differential diagnoses a number of different strategies can be used to generate a differential diagnosis. You will not miss any highrisk causes if you remember this. A patient with chest pain poses one of the most complicated diagnostic challenges.
Ideally, the detailed history is taken where resuscitation facilities are available. Life threatening differential chest pain diagnoses supplemental guide the north dakota department of health is not responsible for inaccuracies contained herein. Patients with palpitations often present to urgent. Abc of emergency differential diagnosis pdf free download. Chest pain is a common pediatric complaint with the average presenting age of 12. Nov 15, 2005 once the clinical examination has narrowed the differential diagnosis, diagnostic testing helps determine whether the patient has a serious condition. Combined hospital and primary care data produced an incidence of cardiac chest pain of 6. Differential diagnosis for chest pain oxford medical education. Chest pain differential diagnosis free questions and answers for doctors and medical student.
Shortness of breath hypotension, tracheal deviation and neck vein distention tachycardia tachypnea cough fatigue cyanosis diagnosis. Differential diagnosis of chest pain pain is a common health condition, and is usually temporary in nature. Churchills pocketbook of differential diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of the clinical approach to the field. Oshea and others published differential diagnosis of chest pain find, read and cite all the research you need on. His medical history was significant for hypertension, and his only medication was hydrochlorothiazide.
Although the etiology is benign in most cases, this symptom may lead to school absences andor restriction of activities and causes considerable anxiety in patients and their families. Gender also plays a role in chest pain complaints, as mis are more common in men over the age of 40 and in women over the age of 50. May 25, 2018 differential diagnosis for abdominal pain based on history and physical examination in spite of the fact that area of stomach pain or abdominal pain directs the underlying assessment, related signs and indications are prescient of certain reasons for pain in the abdomen and can limit the differential diagnosis. Furthermore, within the consideration of lifethreatening causes, patients may be suffering from coronary causes, as well as pulmonary embolism. Alright, so when youre presented with chest symptoms as mentioned above, you have to immediately ask, who is your pappa. Outpatient diagnosis of acute chest pain in adults american. These volumes are intended to be summaries of conferences with paneltype discussions and presentations designed to make available the. Pappa is one the best mnemonics to help memorize chest pain differential diagnosis ddx. Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the us per year.
Outpatient chest pain up to 16% of outpatient chest pain evaluations may never reach a definitive diagnosis. Angina pectoris, chest pain, differential diagnosis, electrocardiography, medical history taking, physical examination, practice guidelines, symptoms. Differential diagnosis for chest pain oxford medical. It is a serious concern for patients and practitioners.
The differential diagnosis is extensive and includes diagnoses that can be imminently lifethreatening. Each of these features can help focus the differential diagnosis see figure 151, table 151. 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. Mi myocardial infarction occurs when blood supply to the myocardium via coronary. Chest pain may be caused by either benign or lifethreatening etiologies and is usually divided into cardiac. Chest pain is a common presenting complaint in children. Aug 20, 2018 chest pain is a common reason parents seek medical attention for their children.
Sections of the guide line were developed for use by patients and their. To understand the differential diagnosis of chest pain requiring cardiac surgical consultation. Acute chest pain frequently starts within were detected in 67 percent of 245 adults with dilated cardiomyopathy with no accompanying cellular immune response. Start studying differential diagnosis chest pain questions. Management of palpitations in urgent care urgent message. Chest pain may be pleuritic or nonpleuritic and acute or chronicrecurrent. Assessment of chest pain differential diagnosis of symptoms bmj. The undifferentiated chest pain patient an introduction to. Differential dx strategies university of massachusetts. Even then, there are lots of young to middle aged, menstruating women complaining of chest pain and quite distressed about it. Table 1 lists the differential diagnosis of chest pain.
This article throws light on some possible diagnosis. The differential diagnosis of chest pain is best remembered using an anatomic approach. It may be described as sharp, dull, pressure, heaviness or squeezing. Request pdf the differential diagnosis of chest pain chest pain is a frequent complaint of patients seeking urgent medical assistance. Hopewell case 2 differential diagnosis of tb 2 case 2. Consideration needs to be given to the structures from the skin to the internal organs. Differential diagnosis when evaluating a patient with acute abdominal pain, the physician should focus on common conditions that cause abdomi. Finally, in this section of the article, you will be able to get access to the abc of emergency differential diagnosis pdf free download file in. Because acute chest pain, depending on its etiology, may be associated with a high risk of death, rapid, goaloriented management is mandatory. Remember that chest pain in women may vary significantly from men. This article describes the causes, assessment and differential diagnosis of musculoskeletal chest wall pain, and the management of its most common causes. An expert algorithm to assist in the diagnosis of chest pain can be found here to go back to the main page on unstable angina, click here overview. Chest pain that radiates to the back, jaw, left arm or left shoulder.
Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. It is important to bear in mind that the complaint is partly determined by cultural factors influencing an individuals interpretation of physiological pain clancy and mcvicar, 2002 and, therefore, a chest pain history plays a major role in the differential diagnosis. There are many causes of chest pain as outlined in table 1 but acute coronary syndrome is one of the potentially more serious causes that require rapid identification and implementation of treatment in an attempt to preserve myocardial function and pre. The cause etiology of chest pain varies according to age, sex, risk factors, type of symptoms etc. In the uk, 1% to 2% of adults attend primary care each year with a new presentation of chest pain. Differential diagnosis of chest pain request pdf researchgate. History of exertional chest pain or exertional syncope. Also, the abc of emergency differential diagnosis pdf free download file is on an online repository for the safer downloading of the file. 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.
Chest pain differential diagnosis linkedin slideshare. Full text full text is available as a scanned copy of the original print version. Contents contributors vii preface ix acknowledgments xi introduction to diff erential diagnosis and diagnosis of common problems 1 abdominal pain 5 ankle pain breast lumps 19 chest pain 27 cough 37 diarrhea 49 dizziness 57 ear discharge 67 ear pain 75 elbow pain 83 enlarged lymph nodes 89 eye discharge 97 eye pain 105 eye redness 111 fatigue 117 foot pain 125. Get a printable copy pdf file of the complete article 1. Coronary syndrome acs or other lifethreatening emergencies suspected. Evaluation of chest pain in 2019 american college of physicians. Chest pain that is reproducible during the physical exam with contact of the chest wall is more indicative of noncardiac chest pain, but still cannot completely rule out acute coronary syndrome. Pulmonary embolism is the most common serious cause, found in. After generating a differential, you may decide that you would like to expand upon it. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Archives ofemergency medicine, 1991, 8, 271273 pleuritic chest pain in a postpartum woman j. The differential diagnosis of chest pain request pdf. Of all patients presenting to primary care with chest pain 12% of all consultations, around 15% are thought to be nonspecific i. Atraumatic shoulder pain for the primary care physician. A case series of 181 adults with clinically suspected the differential diagnosis. Visceral pain is diffuse, deep, poorly localized arising from organs and body cavities.
The differential diagnosis is broad and includes cardiac e. A man in his 70s presenting with chest pain and hematuria. There are several lifethreatening causes of chest pain which need to be evaluated for first, which include. Male female perforated ulcer nonspecific gastritis diverticulitis appendicitis acute cholecystitis the other factor is age over 70 years. This refers to chest pain that is not sharp and is not the patients familiar angina. Chapter 53 approach to the patient with chest pain. Assessment of chest pain differentials bmj best practice. Churchills pocketbook of differential diagnosis pdf 4th.
Patients may call chest symptoms pressure, discomfort, tightness, funny feeling, etc. The initial pivotal points are the acuity of onset of the pain and the presence of. Women often have symptoms of fatigue, tiredness, or sleep disturbances as prodromal symptoms before a cardiac event. Thinking about the differential diagnosis of chest pain can be rewarding as a method of developing thought processes that can improve the prehospital providers skills. Although the differential diagnosis of chest pain is exhaustive, chest pain in children is least likely to be cardiac in origin. It can be divided into heartrelated and nonheartrelated pain. For this reason, in general, additional tests are required to establish the diagnosis. Chest pain is pain or discomfort in the chest, typically the front of the chest. Gastrointestinal disease can cause chest pain, but the history and physical examination are relatively inaccurate for ruling in or ruling out serious gastrointestinal pathology,24 and it is important first to rule out immediately lifethreatening cardiovascular and pulmonary causes of chest pain. Mohit bhasin md, facc norfolk, va american college of. Chest pain is a common reason parents seek medical attention for their children. Chest pain covered extensively in chapter 9 is another pivotal clue in patients with dyspnea.
This new title in the abc series covers the assessment, diagnosis, treatment, and management of the most. In fact, more than 45% of pediatric chest pain cases elude definitive diagnosis. Treatment response treatment begun with ripe sputum culture grew m. Applies to pain of heart, aorta, esophagus, stomach and gall bladder. Nontraumatic chest pain is one of the most common causes of emergency department visits and is common in both inpatients and outpatients. This module represents a multidisciplinary approach to the evaluation of a patient with chest pain in an ed setting, and is designed for medical students of.
Hf in ccc usually presents with evidence of biventricular dysfunction including fatigue, chest pain, the differential diagnosis for chronic chagas cardiomyopathy ccc includes. Differential diagnosis chest pain questions flashcards. The differential diagnosis of chest pain syndrome is broad and disparate, including disease processes that range from nonurgent to life threatening. Before ordering a test elicit patients fears false negative stress testing, invasive procedures, expectations resume exercise with confidence, and define a successful chest pain workup together. Acute chest pain of nontraumatic origin is a common reason for presentation to physicians offices and emergency rooms. Consequently, patients presenting with a complaint of chest pain frequently require serial evaluations, and admission to an observation unit or the hospital. The differential diagnosis is extensive and includes diagnoses that can be. Chest pain is something that cannot be neglected under any circumstances whatsoever. T wave inversion st elevation of 1 mm in limb leads or 2 mm in chest leads on serial ecgs or increased troponin. Evaluation of chest pain differential diagnosis of symptoms. It is the presenting complaint in 1% of clinicbased visits. Differential diagnosis for retrosternal chest pain. Chest pain knowledge for medical students and physicians. The initial pivotal points are the acuity of onset of the pain and the presence of vital sign abnormalities.
Evaluation of chest pain differential diagnosis of. In brief, common causes of dyspnea and pleuritic chest pain are pneumonia, pe. Diagnosing the cause of chest pain american family physician. Chest pain is actually one of the most nuanced symptoms in clinical practice and it is fundamental to be able to differentiate benign from serious etiologies.
At those times adding a different strategy often reveals more conditions. Differential diagnosis of chest pain is generated almost entirely by history, with some addition of exg, chest xray, and specific laboratory exams. However, when we speak of chest pain, the reason behind the same need not be something temporary. Common and important causes of chest pain for doctors and medical students. Pulmonary embolism patients typically present with pleuritic chest pain and shortness of breath, and may have evidence of a concomitant deep vein thrombosis. Other common diagnoses of abdominal pain in men and women are as follows. A thorough history and physical examination will help differentiate a serious cause from a minor problem. Chest pain the guideline is intended for health care professionals, including family physicians, nurses, pediatricians, and others involved in the organization and delivery of health services to provide practical and evidencebased information about management and differential diagnosis of chest pain in adult and pediatric patients. In other situations where immediate admission may not be indicated, a full. This clinical entity is a very common chest wall cause of chest pain and is often found in adolescents under age 21, but it also may occur in adults, which could lead to confusion in the diagnosis. Sudden onset of chest pain that is sharp in nature and may lead to feelings of tightness in the chest. Approach to undifferentiated chest pain in the emergency. Evaluation of abdominal pain in the emergency department. The differential diagnosis of chest pain nursing times.
In rosens emergency medicine concepts and clinical practice 8th ed. Certain strategies work better for different symptoms. In a typical population of patients presenting for the evaluation of acute chest pain in eds, about 15% to 25% have acute mi or unstable. A practical guide to the diagnosis and treatment of acute symptoms and conditions, the abc of emergency differential diagnosis pdf provides a stepbystep guide to emergency differential diagnosis for nonspecialists in a hospital or primary care setting. Causes and diagnosis of chest pain in young females. No responsibility is assumed for damages or liabilities arising from accuracy, content error, or omission. It is the presenting complaint in 1% of officebased visits. Annually, physicians evaluate 600,000 cases of chest pain in patients aged 1021 years, a number that may reflect overwhelming concern about chest pain as a manifestation of cardiac disease as noted in older patients. Differential diagnosis for the advanced practice nurse. Decreased or absent breath sounds over the affected lung. Chest pain pediatrics clerkship the university of chicago. Somatic pain from chest wall, pleura or musculoskeletal system is usually localized to fairly circumscribed area. Populationbased questionnaire studies show about 20% of adults reporting.
Chest pain is one of the most common symptoms in the emergency department, as well as in primary health care. The interdisciplinary management of acute chest pain. Associated symptoms may include pain in the shoulder, arm, upper abdomen or jaw or nausea, sweating or shortness of breath. Rubin department ofmedicine, university ofcalifornia, san francisco case report a26yearold woman,gravida3, para2, cameto the emergencyroomcomplaining ofpleuritic chestpainandshortnessofbreath. Table 1 cardiology causes of chest pain 3 assessment of. He also reported hematuria that started the morning of admission. Two important factors modify the differential diagnosis in patients who present with abdominal pain. Pain due to insufficient blood flow to the heart is.
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