APPROACH TO CHEST PAIN

Dr. Abdul Bari Babar

MBBS, FCPS (CARDIOLOGY)
DIPLOMAT HEART FAILURE (EUROPE)
SENIOR REGISTRAR/ CONSULTANT CARDIOLOGIST
HAMDARD UNIVERSITY HOSPITAL
 Defining chest pain

1. Nature of chest pain

2. Onset

3. Duration

4. Location

5. Severity

6. Precipitating factors

7. Relieving factors
 Defining chest pain
Nature of chest pain:

Retrosternal pain, discomfort, heaviness, pressure, constriction,

squeezing – favors angina

Sharp, increasing with inspiration or lying flat, unlikely angina,

favors pericarditis
 Defining chest pain
Onset and duration

Angina gradually builds up in intensity over few minutes

Sudden onset, ripping/tearing, radiation to upper or lower back,

unlikely angina, favors acute aortic syndrome

Chest pain for few seconds – unlikely angina

 Defining chest pain
Location

Localized to very limited area

Radiating to below umbilicus or hip

 unlikely angina
 Defining chest pain

Severity

Ripping chest pain – worse chest pain of my life, especially

when sudden onset and occurring in hypertensive patient or
patient with bicuspid AV, or known aortic aneurysm – consider
aortic syndrome
 Defining chest pain

Precipitating factors

Physical exercise or emotional stress – common triggers of

angina

Occurrence at lower exercise or at rest, - ACS

Positional ? Non – ischemic

 Defining chest pain

Relieving factors

Relief with GTN, is not necessary for diagnosis of myocardial

ischemia
Figure 2. Index of Suspicion That Chest “Pain” Is Ischemic in Origin
on the Basis of Commonly Used Descriptors.
 Chest pain
Acute chest pain:
•New onset or
•Change from previous in
a)Pattern
b)Intensity
c)Duration

Stable chest pain

•Chronic pain associated with consistent triggers
 INVESTIGATIONS
In ED
•ECG

•Troponin I (Hs)

•Baselines Laboratory tests * Hb, Cr, Bun, LFts, lipid profile

•Echocardiography
•MPS
•CMR
•CCT
APPROACH TO DYSPNEA

Dr. Abdul Bari Babar

FCPS (CARDIOLOGY)
DIPLOMAT HEART FAILURE (EUROPE)
SENIOR REGISTRAR/ CONSULTANT CARDIOLOGIST
HAMDARD UNIVERSITY HOSPITAL
 INVESTIGATIONS
• ECG

• ECHOCARDIOGRAPHY

• X RAY CHEST

• CHEST HRCT/ CONTRAST CT

• D DIMER

• CTPA

• Hb, Cr, Electrolytes

Pedal edema