Differential Diagnosis of Chest Pain Lecture Powerpoint

Question 1

Why is the differential so large for chest pain?

Answer 1

Because many of the afferent nerves (especially the vagal) are from the same source and thus can cause very diffuse symptoms

Question 2

Sharp chest pain or tearing or ripping is likely to be…..

Answer 2

Aortic dissection, PE, pneumothorax, or peridcarditis rather than cardiac in origin

Question 3

Abrupt onset vs gradual worsening of angina or acute coronary syndrome

Answer 3

These generally tend to be gradually worsening opposed to abrupt and sudden onset

Question 4

Does cardiac differential pain get better or worse with eating?

Answer 4

Generally does not impact

Question 5

If a patient has had a _____ or ____ (tests) recently that were negative, then we can rule out cardiac disease of differential. However with ___ test, cannot.

Answer 5

Cardiac catheterization, coronary CT angiogram, stress test

Question 6

Mediastinitis risk factors (4)

Answer 6

• Recent cardiac surgeries
• Esophageal perforation
• trauma
• descending infection from head or neck

Question 7

Acute coronary syndrome risk factors (4)

Answer 7

• smoking
• obesity
• male sex
• cocaine abuse

Question 8

Acute aortic dissection risk factors (4)

Answer 8

• marfan syndrome
• hypertension
• cocaine abuse
• previous aortic surgery

Question 9

pneumothorax risk factors (4)

Answer 9

• smoking
• endometriosis
• HIV infecttion
• SCUBA diving

Question 10

Pulmonary embolus risk factors (4)

Answer 10

• prolonged immobilization
• history of hypercoagulability
• trauma
• cancer

Question 11

Pericardial tamponade risk factors (4)

Answer 11

• malignancy
• uremia
• catheterization
• blunt or penetrating injury

Question 12

S1Q3T3

Answer 12

Classic finding for right heart strain characteristic of pulmonary embolism,

Question 13

Electrical alternans

Answer 13

Classic finding for cardiac tamponade

Question 14

Cardiac troponin I and T test

Answer 14

A cardiac ischemia marker that is seen to be elevated when measured in multiple sessions within 3 hours, peaking at 12 hours, and remain elevated 7-10 days indicating ischemia has occurred

Question 15

D-dimer test

Answer 15

Nonspecific marker for clot formation, often used to detect DVT and potential PE in a patient but could be due to any clotting in the body

Question 16

Cardiac troponin I and T vs creatine Kinase test

Answer 16

Troponin is preferred as CK is less cardiac sensitive compared to CK

Question 17

Hamptom hump

Answer 17

Wedge shaped pleural based defect visible on xray where there is a lack of lung tissue in an area due to PE

Question 18

Westermark sign

Answer 18

Absence of vascular markings distal to the embolus in the lung tissue due to PE as evidenced on a chest xray

Question 19

Gold standard imaging for confirming pericardial effusion or tamponade

Answer 19

bedside ultrasonography

Question 20

Acute coronary syndrome

Answer 20

Any group of clinical symptoms compatible with acute myocardial ischemia which includes ST segment elevation MI (STEMI), unstable angina, crescendo pattern of occurrence (increasing intensity, duration, frequency) or non st segment elevation MI (NSTEMI)

Question 21

HEART score

Answer 21

An algorithm that rates a variety of signs and symptoms to come up with a probability of risk of likelihood of acute coronary syndrome

Question 22

1 diagnostic test for chest pain

Answer 22

EKG

Question 23

Pain that starts in the chest and radiates down to the abdomen is a sign of these 2 pathologies

Answer 23

esophageal rupture or aortic dissection