Evaluation of chest pain differential diagnosis of. At those times adding a different strategy often reveals more conditions. Chest pain may also vary from person to person based upon age, sex, weight, and other differences. Outpatient diagnosis of acute chest pain in adults john r. Chest pain radiating to the left arm mi chest pain worse with movement musculoskeletal pain benefits. It is a serious concern for patients and practitioners. The initial goal in patients presenting with chest pain is to determine if the patient needs to be referred for further testing to rule in or out acute. Oshea and others published differential diagnosis of chest pain find, read and cite all the research you need on. It is important that patients presenting with chest pain are rapidly and skilfully assessed so that the correct working diagnosis can be made and appropriate treatment offered. Epidemiology of chest pain reflects selection bias. Management and differential diagnosis of patients with chest pain chest discomfort. Decreased or absent breath sounds over the affected lung. Em basic chest pain history of stress tests or caths pearl.
Male female perforated ulcer nonspecific gastritis diverticulitis appendicitis acute cholecystitis the other factor is age over 70 years. Chest pain is the chief complaint in about 1 to 2 percent of outpatient visits,1 and although the cause is often noncardiac, heart disease remains the leading cause of death in the united states. Chest pain cardiac or not treat patient as though he is critical until proved otherwise history risk factors, ho ihd, previous rxs, previous chest pain pain heart burn burning. Chest pain may present as a stabbing, burning, aching, sharp, or pressurelike sensation in the chest.
Nice chest pain guideline nice guideline guidelines. Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the us per year. Differential diagnosis for pleuritic chest pain oxford. Pappa is one the best mnemonics to help memorize chest pain differential diagnosis ddx.
Chest pain the guideline is intended for health care professionals, including family physicians, nurses, pediatricians, and others involved in the organization and delivery of health services to provide practical and evidencebased information about management and differential diagnosis of chest pain in adult and pediatric patients. Also, the abc of emergency differential diagnosis pdf free download file is on an online repository for the safer downloading of the file. Chest pain differential diagnosis free questions and answers for doctors and medical student exams. Consideration needs to be given to the structures from the skin to the internal organs.
Sudden onset of chest pain that is sharp in nature and may lead to feelings of tightness in the chest. The differential diagnosis is extensive and includes diagnoses that can be imminently lifethreatening. Abdominal distension abdominal pain acute illness anaesthetics arm weakness atls back pain bleeding problems cardiac arrest chest pain clinical cases clinical presentations collapse cough diarrhoea differential diagnosis dizziness emergencies examination fatigue gastroenterology cases gi bleeding headache itch jaundice joint problems leg pain. Diagnosing the cause of chest pain american family physician. Evaluation of chest pain differentials bmj best practice. Mi myocardial infarction occurs when blood supply to the myocardium via coronary. Physician assistant program emory school of medicine. A patient with chest pain poses one of the most complicated diagnostic challenges. Gastrointestinal chest pain may be very difficult to distinguish from cardiac chest pain, especially in patients with oesophageal spasm. Dr ponka is an assistant professor and dr kirlew is a secondyear resident in the department of family medicine at the university of ottawa in ontario. The quote listen to your patient, he is telling you the diagnosis is attributed to the canadian physician william osler. Pulmonary embolism patients typically present with. Chest pain is one of the most common symptoms in the emergency department, as well as in primary health care. After generating a differential, you may decide that you would like to expand upon it.
Musculoskeletal pain is usually associated with tenderness of the chest wall. Angina pectoris, chest pain, differential diagnosis, electrocardiography, medical history taking, physical examination, practice guidelines, symptoms. You will not miss any highrisk causes if you remember this. Once lifethreatening causes have been ruled out either by patient history, examination, or rapid diagnostics, a more thorough history and examination should be performed to narrow the differential diagnosis and guide further diagnostic workup and therapy. The initial pivotal points are the acuity of onset of the pain and the presence of vital sign abnormalities. Differential diagnosis for retrosternal chest pain oxford. Angina pectoris differential diagnoses medscape reference. May 25, 2018 differential diagnosis for abdominal pain based on history and physical examination in spite of the fact that area of stomach pain or abdominal pain directs the underlying assessment, related signs and indications are prescient of certain reasons for pain in the abdomen and can limit the differential diagnosis. Depending upon the cause, chest pain can have varying qualities sharp, dull, burning, can be located in one or several areas middle of the chest, upper or left chest, back, arms, jaw, neck, or the. Consequently, patients presenting with a complaint of chest pain frequently require serial evaluations, and admission to an observation unit or the hospital. Chest pain is actually one of the most nuanced symptoms in clinical practice and it is fundamental to be able to differentiate benign from serious etiologies. Chest pain differential diagnosis linkedin slideshare. Approach to undifferentiated chest pain in the emergency.
Differential diagnosis of chest pain request pdf researchgate. Nov 15, 2005 chest pain is the chief complaint in about 1 to 2 percent of outpatient visits,1 and although the cause is often noncardiac, heart disease remains the leading cause of death in the united states. Chest pain knowledge for medical students and physicians. Differential diagnosis of abdominal pain anatomic approach anatomic structure diagnosis. Assessment of chest pain differential diagnosis of.
In some cases, chest pain may not even be a symptom of an acute cardiac event. Assessment of chest pain differential diagnosis of symptoms. Certain strategies work better for different symptoms. It usually occurs due to visceral and parietal pleura rubbing over each other but can be due to musculoskeletal or nerverelated pathology. Differential diagnosis of chest discomfort and general approach to. Sections of the guide line were developed for use by patients and their.
Traumatic causes of chest pain are not addressed here. Here are some simplified examples of what a differential diagnosis may look like for some common conditions. According to diagnosispro, there can be more than 440 differential diagnosis of chest pain which includes both serious and well as non serious diseases and health problems. Patients with chest pain present relatively frequently in both general practices and emergency departments. A practical guide to the diagnosis and treatment of acute symptoms and conditions, the abc of emergency differential diagnosis pdf provides a stepbystep guide to emergency differential diagnosis for nonspecialists in a hospital or primary care setting. Differential diagnosis for chest pain oxford medical education. Cause grouping differentials classical history classic examination findings investigation findings initial test, diagnostic test. Chest pain may be caused by either benign or lifethreatening etiologies and is usually divided into cardiac. Colicky abdominal pain no bowel motions or flatus distended, tender abdomen tinkling bowel sounds. The differential diagnosis of chest pain request pdf. Common and important causes of chest pain for doctors and medical students. In virtually every case, the prudent pharmacist will encourage the patient to seek emergency medical care. Disorders with musculoskeletal chest pain as a clinical feature. It is the presenting complaint in 1% of clinicbased visits.
Oza, md, mph, the ohio state university, columbus, ohio. Differential diagnosis of acute chest pain oscestop. Two important factors modify the differential diagnosis in patients who present with abdominal pain. Differential diagnosis for the advanced practice nurse. Describing chest pain chest pain caused by angina or a heart attack may be similar to or different from chest pain caused by other conditions. Shortness of breath hypotension, tracheal deviation and neck vein distention tachycardia tachypnea cough fatigue cyanosis diagnosis.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Chest pain differential diagnosis mnemonic easytoremember ddx. Although the differential diagnosis of chest pain is exhaustive, chest pain in children is least likely to be cardiac in origin. Additionally, patients who complain of chest pain wont always have the expected signs and symptoms. Finally, in this section of the article, you will be able to get access to the abc of emergency differential diagnosis pdf free download file in.
Table 1 lists the differential diagnosis of chest pain. The emory physician assistant program recruits educates and mentors a diverse group of students to become highly regarded physician assistants providing compassionate health care of the highest quality. While chest pain is a wellestablished sign of a heart attack, it can also be caused by many other less. Evaluation of chest pain differential diagnosis of symptoms. Chest pain syndrome is inclusive of symptoms that may be caused by acute myocardial ischemia and includes such diverse complaints as chest pain, chest pressure. Diagnosis for chest pain as mentioned earlier, chest pain can lead to various causes and can be an indication to various health diseases. The differential diagnosis of chest pain is best remembered using an anatomic approach. This section of the guideline addresses the assessment and diagnosis of intermittent stable chest pain in people with suspected stable angina. It is important to be aware of the differential diagnosis, to help to differentiate cardiac pain from other causes of chest pain. May 11, 2018 here are some simplified examples of what a differential diagnosis may look like for some common conditions. This refers to chest pain that is not sharp and is not the patients familiar angina. Cause grouping differentials classical history classic examination findings investigation findings.
According to the national health statistics reports on ambulatory medical care utilization estimates for 2006, 9 million patients had a complaint of chest pain and more than 2. Ideally, the detailed history is taken where resuscitation facilities are available. Alright, so when youre presented with chest symptoms as mentioned above, you have to immediately ask, who is your pappa. Common and important causes of pleuritic chest pain for doctors and medical students. Dec 10, 2002 it is important that patients presenting with chest pain are rapidly and skilfully assessed so that the correct working diagnosis can be made and appropriate treatment offered. Chest pain is a common reason parents seek medical attention for their children. Exclude a diagnosis of stable angina if clinical assessment indicates nonanginal chest pain and there are no other aspects of the history or risk factors raising clinical suspicion. Differential diagnosis for chest pain oxford medical. If the clinical appearance of the patient suggests haemodynamic instability, or if the ecg demonstrates an acute st elevation myocardial infarct or other lifethreatening abnormality, an ambulance should be called immediately by dialling 000. Chest pain is pain or discomfort in the chest, typically the front of the chest. Jun 24, 2014 pleuritic pain pain is aggravated during inspiration and when coughing may indicate a respiratory or musculoskeletal cause of pain.
Chapter 53 approach to the patient with chest pain. Chest pain pediatrics clerkship the university of chicago. Pain that does not clearly fit either category might be called subacute and requires consideration of the differential diagnoses for both acute and chronic pain. Differential dx strategies university of massachusetts. Pain in a sick or unstable patient should generally be managed as acute, since patients with chronic abdominal pain may. The differential diagnosis of chest pain syndrome is broad and disparate, including disease processes that range from nonurgent to life threatening. When you have chest pain, your first thought may be that youre having a heart attack. Pleuritic chest pain refers to pain felt worse on inspiration. The early and correct diagnosis of cardiac chest pain and the subsequent initiation of appropriate therapies have been shown to significantly reduce both morbidity and mortality. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain an algorithm for the evaluation of chest pain guided lecture references brown, j.
In addition to boerhaaves syndrome, the differential diagnoses of chest and abdominal pain should include myocardial infarction, pulmonary embolism, aortic dissection, and pancreatitis. Cpg chest pain en pdf american international health. The cause etiology of chest pain varies according to age, sex, risk factors, type of symptoms etc. Chest pain may be caused by either benign or lifethreatening etiologies and is. Strategies for generating differential diagnoses a number of different strategies can be used to generate a differential diagnosis. Evaluation of abdominal pain in the emergency department. John visits his doctor complaining of pain in his chest. The evaluation of chest pain in the emergency department is discussed elsewhere. The differential diagnosis of chest pain nursing times. Learn history taking, physical examination, ecg changes and lab tests. The causes of chest pain range from lifethreatening conditions to those that are relatively benign. Abc of emergency differential diagnosis pdf free download. Nurses will play an increasing role in the differential diagnosis of chest pain and should be familiar with correct procedures and practice.
The differential diagnosis of chest pain is extensive, including many lethal diagnoses. Annually, physicians evaluate 600,000 cases of chest pain in patients aged 1021 years, a number that may reflect overwhelming concern about chest pain as a manifestation of cardiac disease as noted in older patients. Angina is a common presenting symptom typically, chest pain among patients with coronary artery disease. Differential take your pet mac for a walk the 6 deadly causes of chest pain. See evaluation of the adult with chest pain in the emergency department.
This is especially relevant when a patient presents with chest pain, where differentiation of the type of pain and its likely cause is crucial. Evaluation of chest pain differential diagnosis of symptoms bmj. Chest pain may present in different ways depending upon the underlying diagnosis. Conventional radiography, barium swallow, and, especially, contrastenhanced ct are of great value for the timely detection of boerhaaves syndrome. In the uk, 1% to 2% of adults attend primary care each year with a new presentation of chest pain. Even then, there are lots of young to middle aged, menstruating women complaining of chest pain and quite distressed about it. Other common diagnoses of abdominal pain in men and women are as follows. Causes and diagnosis of chest pain in young females. Chest pain is a common pediatric complaint with the average presenting age of 12. Evaluation of chest pain in 2019 american college of physicians. Furthermore, within the consideration of lifethreatening causes, patients may be suffering from coronary causes, as well as pulmonary embolism, aortic dissection, aortic rupture, pneumothorax, or even esophageal rupture.
Its fast, the common things usually come to mind, and it is how most clinicians think. Myocardial ischemia or infarction, 1076 pericardial disease, 1076. It is the presenting complaint in 1% of officebased visits. Outpatient diagnosis of acute chest pain in adults american. Angina pectoris is the result of myocardial ischemia caused by an imbalance between myocardial blood supply and oxygen demand. Chest pain david ponka, md and michael kirlew, md dr ponka is an assistant professor and dr kirlew is a secondyear resident in the department of family medicine at the university of ottawa in ontario.