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CHART 407

Pain Description Pericarditis

Differential Diagnosis of Chest Pain: Less Common Etiologies


Associated Findings Pulsus paradoxsus Dyspnea Low-grade erratic fever Pericardial friction rub History AMI Dresslers syndrome Tamponade Pericardial effusion

Sudden, sharp Dull, aching Stabbing, knife-like Retrosternum or precordial

Can radiate to neck, left shoulder and arm, back, epigastrium Aggravated by deep inspiration, cough, rotation of the chest Alleviated by sitting up and forward Dissecting Aortic Aneurysm Acute sharp onset w/o warning Tearing, ripping In synch w/heartbeat Lasts for hours or days Upper back, anterior chest, epigastric, shoulders, retrosternal

Elevated neck veins Tachycardia Hiccups Nausea/vomiting Dizziness Generalized malaise Hoarseness Abdominal pain Syncope Diaphoresis Tachycardia Hyper/hypotension Confusion Fever Blood pressure different in each arm

Constrictive pericarditis Myocardial/pericardial injury Connective tissue disease Infection Radiation therapy Neoplasm

Hypertension Congenital heart defects Syphilitic aortitis Blunt trauma Males > 5070 years Third trimester of pregnancy

Radiates to hips, groin, lower extremity, neck, shoulders, costovertebral area, epigastric area, jaw Settles in lower back Spontaneous Pneumothorax Sudden Severe Over lateral thorax

Absent or diminished pulses uni/bilateral Decreased level of consciousness Melena, hematemesis, nausea, vomiting Dyspnea Tachycardia Blood pressure difference in each arm Hyperresonance and decreased breath sounds Severe underlying lung disease Necrotizing pneumonia ARDS High airway pressures while on mechanical ventilation Common ages 1625 years COPD Cystic fibrosis Blebs

Tracheal deviation toward affected side Decreased respiratory excursion Bulging intercostal muscles Cholecystitis Severe abdominal pain Epigastric area Tenderness in abdomen, right upper quadrant May radiate to back and scapula Pancreatitis Extreme epigastric pain, alternating with dull aching sensation Radiates to back, flank Nausea/vomiting Fever Jaundice Changes in bowel habit

Intolerance to fatty foods Hypotension Fever Change in bowel habit Weight loss, malnutrition

AMI = acute myocardial infarction; w/o = without; w/ = with; ARDS = acute respiratory distress syndrome; COPD = chronic obstructive pulmonary disease Sources: Williams, J. L. (2003). Gastroesophageal reflux disease: Clinical manifestations. Gastroenterology Nursing, 26(5), 195200. Zoorob, R. J., & Campbell, J. S. (2003). Acute dyspnea in the office. American Family Physician, 68, 18031810; Lissin, L. W., & Vagelos, R. (2002). Acute aortic syndrome: A case presentation and review of the literature. Vascular Medicine, 7 (4), 281287; Pope, J. H., & Selker, H. P. (2002). Diagnosis of acute cardiac ischemia. Emergency Medical Clinics of North America, 21(1), 2759; and Kontos, M. C. (2001). Evaluation of the emergency department chest pain patient. Cardiology Review, 9 (5), 266275.