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Chest Pain l January 13, 2012l 1
Chest Pain
Moises Auron, MD FAAP Assistant Professor of MedicineCCLCM of CWRU August 28, 2009
Chest Pain l January 13, 2012l 2
Describe differential diagnosis, evaluation, andinitial management of chest pain
Identify risk factors for coronary artery disease
Identify biases that might interfere with clinicalreasoning in determining the cause of chest pain
Objectives
Chest Pain l January 13, 2012l 3
CASE # 1
Emergency Room
33 years old male ±stock broker
Chest pain
Shortness of breath
Palpitations (³I feel I have a butterfly in my chest´)
Chest Pain Cases
Info and Rating
Sections
« prev | next »- Objectives
- CASE # 1
- What characteristics would suggest non-cardiac origin?
- What characteristics would suggest cardiac origin?
- Metabolic Syndrome (NCEP/ATP III)
- Coronary Heart Disease Equivalents
- Back to the Case ±Physical exam
- What Ancillary Tests Would You Order?
- Cardiac enzymes in Myocardial Infarction
- Cardiac microfibrillary thin filament
- Use of Troponin in Acute Chest Pain evaluation
- Troponin in Unstable Angina: Prognostic implications
- Troponin I in Acute Coronary Syndromes
- Back to the Case -EKG
- EKG Leads
- EKG Changes: Ischemia
- EKG Changes: Lesion
- Patophysiology of Acute Coronary Syndromes
- Chest Roentgenogram
- CASE # 2
- Differential diagnosis
- Other important information
- Family History
- What are the patient risk factors?
- Patient symptoms
- What features would suggest GERD/esophageal cause?
- On further interrogation«
- Case continuation«
- Where are you going to send the patient?
- CASE # 3
- Indications for exercise stress testing
- CASE # 4
- What are you going to look for on exam?
- CASE # 5
- What is your diagnosis?
- Risk factors for venous thromboembolism
- Would you order a D-dimer?
- What study would you order next?
- Chest CT scan
- What do you expect to see in an EKG?
- What treatment does she needs?
- CASE #6
- What is your differential diagnosis
- What test do you want to order?
- What is the cause of this patient¶s chest pain?
- Would you perform a thoracentesis?
- Do atelectasis cause fever?
- Take Home Messages
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