Given the seriousness and prevalence of cad, it must lead the differential diagnosis. Differential diagnosis of acute abdominal pain micki raber, msn, fnpc, pnpc cindy herf, msn, fnpc slide 2. Stemi is, as the name implies, an electrocardiographic diagnosis, and the search for it mandates the early ecg within 10 minutes of ed presentation now. Given that some causes of chest pain are potentially lethal, the challenge is to make an accurate diagnosis. Table 1 cardiology causes of chest pain 3 assessment of. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Acute myocardial infarction and chest pain are the two most commonly. Assessment and identification is very important for the nurse. Diagnostic ap proach and differential diagnosis are discussed.
Chest pain is something that cannot be neglected under any circumstances whatsoever. A diagnosis of chest pain and its cause can easily be delayed or missed because chest pain may be mild or vague and for other reasons. 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. A free powerpoint ppt presentation displayed as a flash slide show on id. Chest pain is second only to heart murmur for referral to a pediatric cardiologist. Nov 15, 2005 once the clinical examination has narrowed the differential diagnosis, diagnostic testing helps determine whether the patient has a serious condition. Chest pain that radiates to the back, jaw, left arm or left shoulder. Pulmonary mycobacterium avium complex mac infection is a type of nontuberculous mycobacterial ntm infection.
It is relatively common and continues to pose significant therapeutic challenges. Alright, so when youre presented with chest symptoms as mentioned above, you have to immediately ask, who is your pappa. Chest pain symptoms, diagnosis, treatments and causes. Although not all causes of chest pain in the older adult will lead to fatal events, timely diagnosis based on a history of associated factors and a. Nonocclusive plaque may embed within artery wall, erode and cause acute thrombus or vasospasm. These germs are very common in food, water, and soil. You will not miss any highrisk causes if you remember this. Results of examination and hospital investigations, medical, family and social history, sex and age can be used to determine whether the pain is associated with a heart disease. Take your pet mac for a walk the 6 deadly causes of chest pain. Our new crystalgraphics chart and diagram slides for powerpoint is a collection of over impressively designed datadriven chart and editable diagram s guaranteed to impress any audience. However, when we speak of chest pain, the reason behind the same need not be something temporary.
Chest pain is one of the most common symptoms in the emergency department, as well as in primary health care. Greatest discrepancy between male and female acs presentations are in the under age. There are several lifethreatening causes of chest pain which need to be evaluated for first, which include. Dry pleurisy complicating solitary pulmonary nodules. Absence of chest pain leads to under recognition of the disease and under treatment. The interdisciplinary management of acute chest pain.
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. Ideally, the detailed history is taken where resuscitation facilities are available. Presentations are more similar as men and women age contrary to prior doctrine by age 75 years old, both men and women present without chest pain in 50% of cases. He described a sharp in his chest, 5 out of 10 severity. Gastroesophageal reflux disease gerd and musculoskeletal disorders are common causes of chest pain that can mimic angina exacerbated by activity, sensation of pressure and thus should be considered. The differential diagnosis of chest pain is best remembered using an anatomic approach. Pdf dry pleurisy complicating solitary pulmonary nodules caused. The five deadly causes of chest pain other than myocardial. The differential diagnosis of chest pain sciencedirect. Mohit bhasin md, facc norfolk, va american college of.
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. A 36yearold japanese male presented with chest pain and a subacutely progressive pulmonary nodule. Combined hospital and primary care data produced an incidence of cardiac chest pain of 6. Approach to chest pain and syncope mcmaster university. Outpatient chest pain up to 16% of outpatient chest pain evaluations may never reach a definitive diagnosis. Addressing chest pain in older adults current diagnosis. Chest pain in children is one of the most common reasons for an unscheduled visit to the primary care physicians o. At presentation she complained of chest pain located around the sternum and the. Abstract emergency department management of chest pain is a common, with potentially serious problem. 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. However, to our knowledge the relative frequencies of the causes have not been evaluated. 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.
Chest pain in children usually is not caused by a serious disease, in contrast to chest pain in adults. This usually results from an imbalance in oxygen supply and demand, which is most often caused by plaque rupture with thrombus formation in a coronary vessel, resulting in an acute reduction of blood supply to. Ppt differential diagnosis powerpoint presentation. The differential diagnosis of chest pain syndrome is broad and disparate, including disease processes that range from nonurgent to life threatening. History of exertional chest pain or exertional syncope. Follow a repeatable set of patient assessment steps and interpretation of an ekg to arrive a differential diagnosis for a patient complaining of chest pain. The pain was reported as stabbing in nature and had arisen suddenly while watching television. Dr david ponka, assistant professor, department of family medicine, university of ottawa.
This page explains how to approach a patient with chest pain, focusing on the immediate investigations, common and important possible diagnoses, and. Dry pleurisy complicating solitary pulmonary nodules caused by. According to a cardiology hospital in bangalore, below are the most common causes of chest pain. The approach to patients with possible cardiac chest pain. Mycobacterium avium complex mac lung disease presenting as a solitary pulmonary nodule mac spn is often asymptomatic, is more common in middle to old age, and mimics lung cancer or tuberculoma.
Chest pain is the presenting complaint in over 6 million emergency department visits each year. A case series of 181 adults with clinically suspected the differential diagnosis. However, chest pain in older patients can also be noncardiac in origin or of a cardiac etiology other than coronary artery disease. Multiple causes for treeinbud tib opacities have been reported. Differentiating acute coronary syndrome acs from other, noncardiac causes of chest pain is imperative in emergency practice. Assessment of chest pain differential diagnosis of. 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. The purpose of this study was to determine the relative frequency of causes of tib opacities and identify patterns of disease associated with tib opacities. It is primarily identified by the observance or report of pain by the infant, child or adolescent by reports of distress by parents or caregivers. 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.
Ppt approach to chest pain powerpoint presentation free. Start studying differential diagnosis of chest pain. The pain may radiate to either arm, neck, back or shoulder. It is the presenting complaint in 1% of officebased visits. Because acute chest pain, depending on its etiology, may be associated with a high risk of death, rapid, goaloriented management is mandatory. Chest pain may be caused by either benign or lifethreatening etiologies and is usually divided into cardiac. An approach to the initial care of patients with chest pain an approach to the initial care of patients with chest pain in an emergency department located in a noncardiac center alex a. Angina pectoris angina latin word spasmodicsuffocating pain.
Cause grouping differentials classical history classic examination findings investigation findings initial test, diagnostic test. Onset when did the symptoms start and what were you doing. Outpatient diagnosis of acute chest pain in adults. 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. This refers to chest pain that is not sharp and is not the patients familiar angina. A 38yearold black woman with a medical history significant for hypertension and depression presented to the emergency department with a 2week history of lower back pain. This visit was her second in 1 week with the same symptoms, after attaining minimal pain relief with cyclobenzaprine.
For this reason, in general, additional tests are required to establish the diagnosis. Pulmonary mycobacterium avium complex infection radiology. Objective to identify and assess the performance of clinical decision rules cdr for chest pain in general practice. Differential diagnosis of chest pain flashcards quizlet. Evaluation of chest pain differential diagnosis of. Once the clinical examination has narrowed the differential diagnosis, diagnostic testing helps determine whether the patient has a serious condition. A 38yearold woman with an osteolytic rib lesion chest.
Differential diagnosis for the advanced practice nurse. Differential diagnosis of chest pain pain is a common health condition, and is usually temporary in nature. Populationbased questionnaire studies show about 20% of adults reporting. This article throws light on some possible diagnosis for chest pain.
Chart and diagram slides for powerpoint beautifully designed chart and diagram s for powerpoint with visually stunning graphics and animation effects. Simultaneous fever and pain 12 weeks after viral illness. 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. According to oriolo and albarran1 if the pain is continuous or prolonged, eg. Approach to undifferentiated chest pain in the emergency. A case series of 181 adults with clinically suspected the differential diagnosis includes other conditions.
Ppt differential diagnosis powerpoint presentation free. Sep 01, 2017 pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Owing to his continuous chest pain and subacutely progressive nodules. The pain is typically not localized and is described as a pressure, cramp or crushing sensation. In rosens emergency medicine concepts and clinical practice 8th ed. In the uk, 1% to 2% of adults attend primary care each year with a new presentation of chest pain. Patients with a delayed diagnosis of pe, due to being sent home with a misdiagnosis, were significantly younger, with a higher proportion of pleuromechanical chest pain and haemoptysis on clinical presentation and with a higher proportion of patients with a pulmonary infiltrate on chest xray as compared to patients who. Common and important causes of chest pain for doctors and medical students. Explain the value of a cardiovascular history, the value and limitations of ecg, troponin, and other point of care diagnostics relate how to develop a differential diagnosis for a patient presenting with chest pain. Differential diagnosis for chest pain oxford medical education.
Consideration needs to be given to the structures from the skin to the internal organs. We report herein a case of mac spn in an immunocompetent young adult patient, presenting with persistent chest pain and a subacutely. Acute chest pain frequently starts within were detected in 67 percent of 245 adults with dilated cardiomyopathy with no accompanying cellular immune response. Pulmonary angiogram gold standard visceral chest pain. However, chest computed tomography ct has superior sensitivity and specificity for evaluation of the airways, lung parenchyma, and mediastinum, particularly with the use of multiplanar reformatted and threedimensional. An approach to the initial care of patients with chest. The article focuses on the factors to consider in the differential diagnosis of chest pain. Acute chest pain of nontraumatic origin is a common reason for presentation to physicians offices and emergency rooms. A 21 year old man presented to his general practitioner with intermittent left sided pain in the anterior chest wall associated with neck discomfort. Chest pain is a common complaint of patients presenting to primary care physicians and emergency departments. Differential diagnosis of acute abdominal pain with. Em basic chest pain history of stress tests or caths pearl. First, early and accurate identification of patients with stsegmentelevation myocardial infarction stemi enables provision of emergency reperfusion therapy, which has a major impact on outcome, while accurate identification of patients with other. Chest pain could be caused due to different reasons.
Ischemic chest pain causes a diffuse discomfort over a wide are of the anterior chest wall. Chest pain differential diagnosis linkedin slideshare. Pulmonary embolism patients typically present with pleuritic chest pain and shortness of breath, and may have evidence of a concomitant deep vein thrombosis. Pappa is one the best mnemonics to help memorize chest pain differential diagnosis ddx. Differential diagnosis of chest pain anxietyemotion cardiac aortic oesophageal lungspleura musculoskeletal neurological. In addition, the role of mac in pulmonary pathology remains controversial in many instances. Chest pain may be caused by either benign or lifethreatening etiologies and is. Evaluation of chest pain differential diagnosis of symptoms. Angina pectoris myocardial infarction non cardiac related. Explore the characteristics of the chest pain first. Exam is normal, ekg is normal and nonischemic, chest xray normal, and cardiac enzymes are normal as well.
Lungs and heart cause the most alarming situations when these are the reasons behind the chest pain. The cause etiology of chest pain varies according to age, sex, risk factors, type of symptoms etc. Pain of moderate severity, localized to the mid or upper sternal region, with or without radiation and not associ ated with appreciable weakness, must be differentiated from the more common causes of chest pain of this magnitude, namely, acute coronary failure, benign idiopathic pericarditis, pulmo nary embolism, spinal root compression and. Abdominal pain is one of the most frequent complaints in primary care most patients with abdominal pain have minor, nonsurgical causes. Chest pain in children is the pain felt in the chest by infants, children and adolescents. Because thoracic involvement often predominates, chest radiographic findings are often the first to suggest the diagnosis. Muscle strain musculoskeletal pericarditis eosophagitis pulmonary embolism acute indigestion intestinal gas. Myocardial infarction, commonly known as a heart attack, is the irreversible necrosis of heart muscle secondary to prolonged ischemia.
A general term for any dull, aching pain in the thorax. Cardiac related non cardiac related cardiac related. Nov 06, 2015 acute chest pain of nontraumatic origin is a common reason for presentation to physicians offices and emergency rooms. One prospective cohort study identified four clinical factors that predict a final diagnosis of chest wall pain in patients presenting to the primary care office with chest pain. Additionally, to help rule out an ischemic cause of chest pain, ask about any history self or. Learning outcome definition type of chest pain etiology characteristic of cardiac chest pain ischaemic cardiac pain vs noncardiac chest pain differential diagnosis 3. Depending on the suspected cause of chest pain, other tests can include additional blood tests, culture and sensitivity tests, pulmonary function test, and imaging tests, such as ct scan, nuclear scans, and mri. Coronary heart disease is the cause in up to 25% of cases.
He had no history of trauma before the onset of symptoms, and the pain was not exacerbated by inspiration or effort. Diagnosing the cause of chest pain american family physician. Noncardiac origins of chest pain include pulmonary and esophageal. Pain is a common health condition, and is usually temporary in nature. It is the presenting complaint in 1% of clinicbased visits. Pulmonary embolism is the most common serious cause, found in. Differential diagnosis of chest pain sciencedirect.
Chest pain and neck discomfort in a young man the bmj. Mycobacterium avium complex mac is a group of bacteria related to tuberculosis. See evaluation of the adult with chest pain in the emergency department. Common and uncommon manifestations of wegener granulomatosis. Study selection studies that assessed cdrs for intermittenttype chest pain and for rule out of acute. The differential diagnosis of chest pain in a patient with sickle cell disease is. No single finding is absolutely pathognomonic nor completely reassuring in chest pain presentation. These include quality, location, duration, intensity, accompanying symptoms, aggravating and alleviating factors, as well as the relationship between any type of exertion and pain experienced. There is a dichotomy in the assessment of patients with possible acs. Differential diagnosis for chest pain oxford medical. Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the us per year. Assessment of chest pain differential diagnosis of symptoms. Mar 20, 2015 learning outcome definition type of chest pain etiology characteristic of cardiac chest pain ischaemic cardiac pain vs noncardiac chest pain differential diagnosis 3.