1 / 94

Cardiac Differential Diagnosis

Cardiac Differential Diagnosis. Will/Grundy EMS Continuing Education January 2011 Written by: -Laurie Carroll, RN, Advocate Bolingbrook Hospital -Will/Grundy EMS Staff. Differential Diagnosis of Chest Pain.

robyn
Download Presentation

Cardiac Differential Diagnosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cardiac Differential Diagnosis Will/Grundy EMS Continuing Education January 2011 Written by: -Laurie Carroll, RN, Advocate Bolingbrook Hospital -Will/Grundy EMS Staff

  2. Differential Diagnosis of Chest Pain • There are literally dozens of illnesses, injuries and conditions that can cause chest pain. • Knowing common signs, symptoms and patient presentations can help you differentiate between different kinds of chest pain. • Bottom Line: If you are ever not sure what kind of chest pain you are dealing with, treat it as cardiac and call medical control.

  3. Differential Diagnosis of Chest Pain Common Causes of Chest Pain • Cardiovascular: • ischemia (AMI or angina) • pericarditis (irritation of pericardium) • thoracic aortic dissection

  4. Differential Diagnosis of Chest Pain Common Causes of Chest Pain • Respiratory: • PE (pulmonary embolism) • pneumothorax • pneumonia • pleural irritation • hyperventilation (anxiety)

  5. Differential Diagnosis of Chest Pain Common Causes of Chest Pain • Gastrointestinal: • cholecystitis (gall bladder/gallstones) • pancreatitis • hiatal hernia (part of stomach pushes through diaphragm) • esophageal disease/GERD • peptic ulcers • dyspepsia (indigestion)

  6. Differential Diagnosis of Chest Pain Common Causes of Chest Pain • Musculoskeletal: • chest wall syndrome (inflamed chest wall) • costochondritis (inflamed rib cartilage) • herpes zoster (shingles) • chest wall trauma • chest wall tumors

  7. QUESTIONS TO HELP DIFFERENTIATE CHEST PAIN • CAUSE • ONSET OF PAIN • CHARACTERISTIC OF PAIN • LOCATION OF PAIN • HISTORY • ASSOCIATED SX/SX • AGGRAVATING FACTORS • RELIEVING FACTORS

  8. DETERMINE ONSET/DURATION OF PAIN Was it… Sudden? Gradual? Lasts Minutes? Lasts Hours? Varies?

  9. “QUALITY” OF PAIN • PLEURITIC (sharp pain with inhalation) • SPASMODIC (like a spasm) • TIGHTNESS OR HEAVINESS • PRESSURE- OPPRESSIVE • SHARP/LOCALIZED (easy to pinpoint) • VISCERAL (hard to pinpoint)/BURNING • TEARING / EXCRUCIATING

  10. LOCATION • SUBSTERNAL • CENTER OR ACROSS CHEST • LATERAL CHEST • LOCALIZED OVER INVOLVED AREA • LOWER CHEST/EPIGASTRIC • RADIATES TO JAW, NECK, BACK OR ARM • VAGUE

  11. HISTORY • AGE • PREVIOUS EPISODES • UPPER RESPIRATORY INFECTION/FEVER • TRAUMA • STRESS • EMOTIONAL UPSET • CARDIAC DISEASE – HTN, CAD, ANGINA • PHLEBITIS

  12. Associated Signs/Symptoms? • DYSPNEA • DIAPHORESIS • NAUSEA / VOMITING • AMS /WEAKNESS /LIGHTHEADEDNESS / SYNCOPE • NEURO CHANGES • HYPO OR HYPERTENSION OR UNEQUAL BP • DECREASED OR ABNORNMAL BREATH SOUNDS • CYANOSIS • HEMOPTYSIS (coughing up blood) • PULSATING ABD MASS • ABDOMINAL PAIN • VESICULAR PAIN WITH PALPATION • RASH OR LESIONS

  13. AGGRAVATING FACTORS? • BREATHING • MOVEMENT • STRESS • EXERTION • AFTER EATING OR ETOH • LAYING DOWN • SITUATIONAL / ANXIETY

  14. RELIEVING FACTORS – What makes it feel better? REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS

  15. Now lets match the chest pain diagnosis with the symptoms…. The list items in red italics are the ones that go with the diagnosis….

  16. ANGINAONSET/DURATION OF PAIN • Sudden • Gradual • Lasts Minutes • Lasts Hours • Varies

  17. ANGINA QUALITY • PLEURITIC • SPASMODIC • TIGHTNESS OR HEAVINESS • PRESSURE- OPPRESSIVE • SHARP/LOCALIZED VISCERAL/BURNING • TEARING / EXCRUCIATING

  18. ANGINALOCATION • SUBSTERNAL • CENTER OR ACROSS CHEST • LATERAL CHEST • LOCALIZED OVER INVOLVED AREA • LOWER CHEST/EPIGASTRIC • RADIATES TO JAW, NECK, BACK OR ARM • VAGUE

  19. ANGINA HISTORY • AGE • PREVIOUS EPISODES • UPPER RESPIRATORY INFECTION/FEVER • TRAUMA • STRESS • EMOTIONAL UPSET • CARDIAC DISEASE – HTN, CAD, ANGINA • PHLEBITIS

  20. ANGINA ASSOCIATED SX / SX • DYSPNEA • DIAPHORESIS • NAUSEA / VOMITING • AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE • NEURO CHANGES • HYPO OR HYPERTENSION OR UNEQUAL BP • DECREASED OR ABNORNMAL BREATH SOUNDS • CYANOSIS • HEMOPTYSIS • PULSATING ABD MASS • ABDOMINAL PAIN • VESICULAR PAIN WITH PALPATION • RASH OR LESIONS

  21. ANGINA AGGRAVATING FACTORS • BREATHING • MOVEMENT • STRESS • EXERTION • AFTER EATING OR ETOH • LAYING DOWN • SITUATIONAL / ANXIETY

  22. ANGINA RELIEVING FACTORS • REST OR DECREASED MOVEMENT • POSITION • SITTING UP OR LEANING FORWARD • DECREASED OR SHALLOW BREATHING • DIET • ANTACIDS • MEDICATIONS

  23. Acute Myocardial InfarctionONSET/DURATION OF PAIN • Sudden • Gradual • Lasts Minutes • Lasts Hours • Varies

  24. Acute Myocardial InfarctionQUALITY • PLEURITIC • SPASMODIC • TIGHTNESS OR HEAVINESS • PRESSURE- OPPRESSIVE • SHARP/LOCALIZED VISCERAL/BURNING • TEARING / EXCRUCIATING

  25. Acute Myocardial InfarctionLOCATION • SUBSTERNAL • CENTER OR ACROSS CHEST • LATERAL CHEST • LOCALIZED OVER INVOLVED AREA • LOWER CHEST/EPIGASTRIC • RADIATES TO JAW, NECK, BACK OR ARM • VAGUE

  26. Acute Myocardial Infarction HISTORY • AGE • PREVIOUS EPISODES • UPPER RESPIRATORY INFECTION/FEVER • TRAUMA • STRESS • EMOTIONAL UPSET • CARDIAC DISEASE – HTN, CAD, ANGINA • PHLEBITIS

  27. Acute Myocardial InfarctionASSOCIATED SX / SX • DYSPNEA • DIAPHORESIS • NAUSEA / VOMITING • AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE • NEURO CHANGES • HYPO OR HYPERTENSION OR UNEQUAL BP • DECREASED OR ABNORNMAL BREATH SOUNDS • CYANOSIS • HEMOPTYSIS • PULSATING ABD MASS • ABDOMINAL PAIN • VESICULAR PAIN WITH PALPATION • RASH OR LESIONS

  28. Acute Myocardial InfarctionAGGRAVATING FACTORS • BREATHING • MOVEMENT • STRESS • EXERTION • AFTER EATING OR ETOH • LAYING DOWN • SITUATIONAL / ANXIETY

  29. Acute Myocardial InfarctionRELIEVING FACTORS • REST OR DECREASED MOVEMENT • POSITION • SITTING UP OR LEANING FORWARD • DECREASED OR SHALLOW BREATHING • DIET • ANTACIDS • MEDICATIONS

  30. Dissecting AneurysmONSET/DURATION OF PAIN • Sudden • Gradual • Lasts Minutes • Lasts Hours • Varies

  31. Dissecting Aneurysm QUALITY • PLEURITIC • SPASMODIC • TIGHTNESS OR HEAVINESS • PRESSURE- OPPRESSIVE • SHARP/LOCALIZEDVISCERAL/BURNING • TEARING / EXCRUCIATING

  32. Dissecting AneurysmLOCATION • SUBSTERNAL • CENTER OR ACROSS CHEST • LATERAL CHEST • LOCALIZED OVER INVOLVED AREA • LOWER CHEST/EPIGASTRIC • RADIATES TO JAW, NECK, BACK OR ARM • VAGUE • ABDOMEN

  33. Dissecting Aneurysm HISTORY • AGE • PREVIOUS EPISODES • UPPER RESPIRATORY INFECTION/FEVER • TRAUMA • STRESS • EMOTIONAL UPSET • CARDIAC DISEASE – HTN, CAD, ANGINA • PHLEBITIS

  34. Dissecting Aneurysm ASSOCIATED SX / SX • DYSPNEA • DIAPHORESIS • NAUSEA / VOMITING • AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE • NEURO CHANGES • HYPO OR HYPERTENSION OR UNEQUAL BP • DECREASED OR ABNORNMAL BREATH SOUNDS • CYANOSIS • HEMOPTYSIS • PULSATING ABD MASS • ABDOMINAL PAIN • VESICULAR PAIN WITH PALPATION • RASH OR LESIONS

  35. Dissecting Aneurysm AGGRAVATING FACTORS • BREATHING • MOVEMENT • STRESS • EXERTION • AFTER EATING OR ETOH • LAYING DOWN • SITUATIONAL / ANXIETY • In other words, it hurts badly no matter what.

  36. Dissecting Aneurysm RELIEVING FACTORS • REST OR DECREASED MOVEMENT • POSITION • SITTING UP OR LEANING FORWARD • DECREASED OR SHALLOW BREATHING • DIET • ANTACIDS • MEDICATIONS • In other words, nothing helps it feel better.

  37. PERICARDITISONSET/DURATION OF PAIN • Sudden • Gradual • Lasts Minutes • Lasts Hours • Varies

  38. PERICARDITIS QUALITY • PLEURITIC • SPASMODIC • TIGHTNESS OR HEAVINESS • PRESSURE- OPPRESSIVE • SHARP/LOCALIZED VISCERAL/BURNING • TEARING / EXCRUCIATING

  39. PERICARDITIS LOCATION • SUBSTERNAL • CENTER OR ACROSS CHEST/RETROSTERNAL • LATERAL CHEST • LOCALIZED OVER INVOLVED AREA • LOWER CHEST/EPIGASTRIC • RADIATES TO JAW, NECK, BACKOR ARM • VAGUE

  40. PERICARDITIS HISTORY • AGE • PREVIOUS EPISODES • UPPER RESPIRATORY INFECTION/FEVER • TRAUMA • STRESS • EMOTIONAL UPSET • CARDIAC DISEASE – HTN, CAD, ANGINA • PHLEBITIS

  41. PERICARDITIS ASSOCIATED SX / SX • DYSPNEA • DIAPHORESIS • NAUSEA / VOMITING • AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE • NEURO CHANGES • HYPO OR HYPERTENSION OR UNEQUAL BP • DECREASED OR ABNORNMAL BREATH SOUNDS • CYANOSIS • HEMOPTYSIS • PULSATING ABD MASS • ABDOMINAL PAIN • VESICULAR PAIN WITH PALPATION • RASH OR LESIONS • PARADOXICAL PULSE

  42. PERICARDITIS AGGRAVATING FACTORS • BREATHING • MOVEMENT • STRESS • EXERTION • AFTER EATINGOR ETOH • LAYING DOWN • SITUATIONAL / ANXIETY

  43. PERICARDITISRELIEVING FACTORS • REST OR DECREASED MOVEMENT • POSITION • SITTING UP OR LEANING FORWARD • DECREASED OR SHALLOW BREATHING • DIET • ANTACIDS • MEDICATIONS

  44. PNEUMOTHORAXONSET/DURATION OF PAIN • Sudden • Gradual • Lasts Minutes • Lasts Hours • Varies

  45. PNEUMOTHORAX QUALITY • PLEURITIC • SPASMODIC • TIGHTNESS OR HEAVINESS • PRESSURE- OPPRESSIVE • SHARP/LOCALIZED VISCERAL/BURNING • TEARING / EXCRUCIATING

  46. PNEUMOTHORAX LOCATION • SUBSTERNAL • CENTER OR ACROSS CHEST • LATERAL CHEST • LOCALIZED OVER INVOLVED AREA • LOWER CHEST/EPIGASTRIC • RADIATES TO JAW, NECK, BACK OR ARM • VAGUE

  47. PNEUMOTHORAX HISTORY • AGE • PREVIOUS EPISODES • UPPER RESPIRATORY INFECTION/FEVER • TRAUMA • STRESS • EMOTIONAL UPSET • CARDIAC DISEASE – HTN, CAD, ANGINA • PHLEBITIS

  48. PNEUMOTHORAX ASSOCIATED SX / SX • DYSPNEA • DIAPHORESIS • NAUSEA / VOMITING • AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE • NEURO CHANGES • HYPO OR HYPERTENSION OR UNEQUAL BP • DECREASED OR ABNORNMAL BREATH SOUNDS • CYANOSIS • HEMOPTYSIS • PULSATING ABD MASS • ABDOMINAL PAIN • VESICULAR PAIN WITH PALPATION • RASH OR LESIONS

  49. PNEUMOTHORAX AGGRAVATING FACTORS • BREATHING • MOVEMENT • STRESS • EXERTION • AFTER EATING OR ETOH • LAYING DOWN • SITUATIONAL / ANXIETY

  50. PNEUMOTHORAXRELIEVING FACTORS • REST OR DECREASED MOVEMENT • POSITION • SITTING UP OR LEANING FORWARD • DECREASED OR SHALLOW BREATHING • DIET • ANTACIDS • MEDICATIONS

More Related