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CHEST PAINANGINA

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CHEST PAINANGINA

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    1. CHEST PAIN/ANGINA Joshua M. Crasner, DO, FACC, FACOI

    3. chest pain 3 QUALITY/CHARACTER: Pain pressing, squeezing sensation burning constricting sine quo non symptoms are “band across the chest” or “weight in center of chest”

    4. chest pain 4 Anginal Equivalent may not be typical symptoms indigestion dizziness diaphoresis exhaustion faintness nausea/vomiting palpitations

    5. chest pain 5 DURATION angina is usually of short duration; 2-10 min musculoskeletal etiology typically brief, sharp, lancinating pain hours-long pain: acute MI, pericarditis, aortic dissection

    6. chest pain 6 PRECIPITATING FACTORS angina usually exertional, except Prinzmetal’s ischemia: the patient may become restless, or pain much more severe than that of angina/MI(viable myocardium) postprandial postcoitus nocturnal/early AM cold air exposure inclines, steps

    7. chest pain 7 RELIEVING FACTORS nitroglycerin: esophageal spasm esophagitis, angina rest oxygen medicines(at home): nitro, antacids, anti-anginals, pain remedies, anxiolytics food, beverage massage, stretching, position change

    8. chest pain 8 DIFFERENTIAL DIAGNOSIS

    9. chest pain 9 ESOPHAGEAL Spasm reflux esophagitis Mallory-Weiss tear Symptoms: belching, heartburn, spasmodic pain

    10. chest pain 10 BILIARY COLIC steady pain lasting 2-4 hrs. radiation of pain: epigastrium, precordium, right shoulder

    11. chest pain 11 CERVICAL RADICULITIS constant ache related to cervical motion brachial plexus hands, arm involvement

    12. chest pain 12 SYNDROME X angina-like pain with normal coronaries females more frequent can have ischemic ECG

    13. chest pain 13 ACUTE PULMONARY HYPERTENSION similar quality pain as angina across entire precordium, more severe not usually exertional pulmonary embolism, pulmonic stenosis Physical exam: RV lift, TR, SEM of PS

    14. chest pain 14 ACUTE PERICARDITIS usually preceded by URI sharp, pleuritic, often left-sided aggravated by position, better sitting forward hours in length not relieved by anti-anginals absence of rub does not exclude

    15. chest pain 15 AORTIC DISSECTION ripping, tearing sensation persistent severe pain with radiation to back lasting for hours pain usually worse at its onset most common in patients with HTN

    16. chest pain 16 MUSCULOSKELETAL COSTOCHONDRITIS/MYOSITIS local tenderness aggravated by cough, motion Tietze syndrome(costrochondral)

    17. chest pain 17 PSYCHOGENIC PAIN Da Costa syndrome dull persistent ache for hours unrelated to exertion occurs with fatigue other emotionally unstable signs present

    18. chest pain 18 Other Entities Anomalous coronary artery aortic stenosis mitral valve prolapse/stenosis(rare)

    19. chest pain 19 EVALUATION AND TREATMENT AT BEDSIDE brief, directed history and physical ECG, CXR, ABG, labs where appropriate treat the underlying cause, not just the symptoms transfer of patient and/or evalution of patient by others more experienced 2D Echo/Doppler if available and/or TEE where appropriate oxygen, reposition patient, IV site, monitor

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