Chest Pain

Cardiac Causes

Disorder

Typical characteristics

Other S/S; Dx studies

Angina

substernal pressure -» neck. jaw. arm duration < 30 min : dyspnea, diaphoresis. N/V t w/ exertion; i w/ NTG or rest however, relief by NTG in ED not reliable indicator (<Wi em 20054S:S81)

t ECG As (ST J/T.TWI)

Ml

same as angina but I intensity duration -30 min

• ECG As (ST î/i.TWI) © troponin or CK-MB

Pericarditis

sharp pain radiating to trapezius aggravated by respiration relieved by sitting forward

• pericardial friction rub ECG As (diffuse ST T & PR 1) pericardial effusion

Myocarditis

same as above

same as above. : ? Tn & CHF

Aortic dissection

sudden onset tearing, knifelike pain anterior or posterior mid-scapular

hyper- or hypotension asymmetric BP/pulses; new AI widened mediastinum on CXR false lumen on imaging

Pulmonary Causes

Disorder

Typical characteristics

Other S/S; Dx studies

Pneumonia

pleuritic dyspnea, fever, cough, sputum

fever, tachypnea, crackles infiltrate on CXR

Pleuritis

sharp, pleuritic

• pleural friction rub

Pneumothorax

unilateral, sharp, pleuritic sudden onset

unilateral hyperresonance, I BS. PTX on CXR

PE

pleuritic sudden onset

tachypnea, tachycardia, hypoxemia TWIV, V4.RAD.RBBB.0CCSTEV, V, @ CTA.V/Q scan or angiogram

Pulmonary HTN

dyspnea, exertional pressure

hypoxemia, loud Pj. right-sided S3 & S4

Gl Causes

Disorder

Typical characteristics

Other SIS; Dx studies

Esophageal reflux

substernal burning acid taste in mouth; water brash t by meals, recumbency, i by antacids

esophageal pH probe Bernstein acid perfusion test EGD

Esophageal spasm

intense substernal pain t by swallowing. 1 by NTG or CCB

upper Gl series manometry

Mallory-Weiss tear

precipitated by vomiting

EGD

Boerhaave's syndrome

precipitated by vomiting severe pain, t with swallowing

palpable SC emphysema mediastinal air on chest CT

Peptic ulcer disease

epigastric pain relieved by antacids - hematemesis. melena

± H. pybri test

Biliary disease

RUQ pain, nausea/vomiting aggravated by fatty foods

RUQ U/S. LFTs rarely inferior STE

Pancreatitis

epigastric/back discomfort

t amylase & lipase, abd CT

Musculoskeletal and Miscellaneous Causes

Disorder

Typical characteristics

Other S/S; Dx studies

Costochondritis

localized sharp or dull pain

tenderness to palpation

Cervical spine disease/OA

precipitated by motion, lasts sec to h

x-rays

Herpes zoster

intense unilateral pain

dermatomal rash & sensory findings

Anxiety

"tightness"

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