Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
2Activity
0 of .
Results for:
No results containing your search query
P. 1
Chest pain

Chest pain

Ratings: (0)|Views: 28|Likes:
Published by dmorcf
chapters from clinical medicine
chapters from clinical medicine

More info:

Published by: dmorcf on Dec 31, 2012
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

06/24/2014

pdf

text

original

 
Evans-978-0-7234-3-421-4
B978-0-7234-3461-0.00001-4, 00001
 
Parker, 978-0-7234-3461-0
B978-0-7234-3461-0.00001-4, 00001
12. Abdominal pain 6713. Polyuria and polydipsia 7314. Haematuria and proteinuria 7915. Hypertension 8516. Headache and facial pain 8917. Joint disease 9518. Skin diseases 10119. Loss of consciousness 10720. Confusional states 11521. Acute neurological deficit 12122. Lymphadenopathy andspienomegaly 12723. Sensory and motor neurologicaldeficits 13324. Bruising and bleeding 14125. Vertigo and dizziness 14726. Anaemia 153
THE PATIENT PRESENTSWITH
1. Chest pain 32. Shortness of breath 93. Palpitations 154. Heart murmurs 215. Cough and haemoptysis 296. Pyrexia of unknown origin 357. Dyspepsia 398. Haematemesis and melaena 439. Change in bowel habit 4910. Weight loss 5511. Jaundice 61
0000756322.INDD 1
0000756322.INDD 1
2/7/2008 6:36:11 AM
2/7/2008 6:36:11 AM
 
0000756322.INDD 2
0000756322.INDD 2
2/7/2008 6:36:12 AM
2/7/2008 6:36:12 AM
 
Parker, 978-0-7234-3461-0
3
1
B978-0-7234-3461-0.00001-4, 00001
Chest pain
 
INTRODUCTION
Chest pain is a common cause for both referraland admission to hospital. It has many possibleaetiologies that need to be elucidated. Taking a clear history is essential in making the correct diagnosis.
DIFFERENTIAL DIAGNOSISOF CHEST PAIN
Pleuritic chest pain
 This is a sharp pain that is worse on deep inspiration,coughing or movement. The differential diagnosisincludes the following: Pneumothorax.Pneumonia.Pulmonary embolus.Pericarditis: retrosternal.
Central chest pain
 The differential diagnosis of central pain includes thefollowing:  Angina: crushing/tightness.Myocardial infarction: angina-like but more severe,long-lasting and with associated symptoms.Dissecting aortic aneurysm: tearing interscapular pain.Oesophagitis: burning.Oesophageal spasm.
Chest wall tenderness
 The differential diagnosis of chest wall tendernessincludes the following:
 Rib fracture.Shingles (herpes zoster): pain precedes rash.Costochondritis (Tietze’s syndrome).
Atypical presentations
 The differential diagnosis in atypical presentations(or in any of the above) includes anxiety andreferred pain from vertebral collapse causing nerveroot irritation or intra-abdominal pathology (e.g.pancreatitis, peptic ulcer or biliary tree disorders).
HISTORY IN THE PATIENTWITH CHEST PAIN
 A careful history of the chest pain will generally besuggestive of the likely underlying problem. Thefocus should then turn to any associated symptomsand risk factors.
What type of chest pain does thepatient have?
Onset and progression of pain
Cardiac ischaemic pain typically builds up over a few minutes and may be brought on by exercise, emotionor cold weather. In angina, the pain resolves on resting or with nitrate (GTN) usage. It is often reproducible with consistent effort. In unstable angina, the painmay come on at rest or be of increasing frequency or severity. In myocardial infarction (MI), the painis severe, often associated with systemic symptomssuch as nausea, vomiting and sweating, lasts for at least 30 minutes and is not usually fully relieved by GTN. Spontaneous pneumothorax and pulmonary embolism usually cause sudden onset of pleuritic 
 In this chapter you will learn to:Understand the causes of chest pain.Have a systematic approach to assessing a patient presenting with chest pain.Understand the sequence of investigations in a patient with chest pain.
00001
Objectives
0000756322.INDD 3
0000756322.INDD 3
2/7/2008 6:36:12 AM
2/7/2008 6:36:12 AM

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->