Chest Pain. James Nixon, MD Assistant Professor Internal Medicine and Pediatrics. Case #1. A 65 year old female comes to the emergency room after awakening at 7:00 AM with Chest pain and SOB. Her husband is concerned that she might be having a heart attack.
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James Nixon, MD
Internal Medicine and Pediatrics
A 65 year old female comes to the emergency room after awakening at 7:00 AM with Chest pain and SOB. Her husband is concerned that she might be having a heart attack.
SituationWhat characteristics of the chest pain might make you more concerned for cardiac chest pain?
may suggest seriousness of symptoms.
marked difference in blood pressure between arms suggests aortic dissection
Palpate the chest wall
Hyperesthesia may be due to herpes zoster
Complete cardiac examination
signs of acute AI or AS
Ischemia may result in MI murmur, S4 or S3
Determine if breath sounds are symmetric and if wheezes, crackles or evidence of consolidationAny exam findings that might help distinguish cardiac from non cardiac chest pain?
Fesmire FM; Percy RF; Bardoner JB; Wharton DR; Calhoun FB. Serial creatinine kinase (CK) MB testing during the emergency department evaluation of chest pain: utility of a 2-hour delta CK-MB of +1.6ng/ml. Am Heart J 1998 Aug;136(2):237-44
A 57 year old male comes to Clinic complaining of substernal chest pain that comes on with exertion and goes away with rest.
Von kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Archives of Internal Medicine 2000;160:2977.
A 72 year old obese diabetic male complains of 2-3 month history of progressive fatigue and more trouble with his breathing when he is doing housecleaning. He also is concerned because for the past two weeks he is waking up short of breath in the middle of the night.