CHEST PAIN

Chest pain

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Identify risk factors for coronary artery disease Identify biases that might interfere with clinical reasoning in determining the cause of chest pain

Emergency Room 55 years old male self emplyed Chest pain Shortness of breath Palpitations (I feel I have a butterfly in my chest)

What information would you want to know?

What activities precipitate pain? stress (business partener /deals/stress of any form); sudden onset What alleviates pain? rest,taking medication,lying Quality of the pain sharp, stabbing Associated symptoms Diaphoresis; impending death feeling Where is the pain located? retrosternal with no radiation Severity of pain 6/10 How long since episodes first began? Weekly for the past month.

Other important information

Past medical history
Diabetes mellitus diagnosed at age 12 y/o HbA1c 12 No history of syncope

 Social History
Smoker 2 ppd for the past 5 years. Use Ritalin and cocaine weekly for the past year Family History Father had a Myocardial Infarction at Age 57 y/o No history of syncope or sudden cardiac death

What characteristics would suggest cardiac origin?

Age and Sex (Male > 45 y/o; Female > 55 y/o) Smoker increase risk of CAD 2-4x Diabetes increase risk of mortality 2-4x Drug use Associated symptoms (autonomic features) Family history (Male < 55 y/o; Female < 65 y/o) Risk factors (Total cholesterol, LDL, HDL, Hypertension)

Framingham Study Others (Obesity, Sedentarism) Metabolic Syndrome

Patophysiology of Acute Coronary Syndromes