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| Hi
| | == Heading== |
|
| |
|
| {|
| | ===Subheading=== |
| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| |
| ! rowspan="3" |Differentials on the basis of Etiology
| |
| ! rowspan="3" |Disease
| |
| ! colspan="10" |Clinical manifestations
| |
| ! colspan="4" |Diagnosis
| |
| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| |
| ! colspan="8" |Symptoms
| |
| ! rowspan="2" |Risk factors
| |
| ! rowspan="2" |Physical exam
| |
| ! rowspan="2" |Lab Findings
| |
| ! rowspan="2" |EKG
| |
| ! rowspan="2" |Imaging
| |
| ! rowspan="2" |Gold standard
| |
| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| |
| !Onset
| |
| !Duration
| |
| !Quality of Pain
| |
| !Cough
| |
| !Fever
| |
| !Dyspnea
| |
| !Weight loss
| |
| !Associated Features
| |
| |- style="background: #DCDCDC; padding: 5px;" |
| |
| |
| |
| !'''[[Stable Angina]]'''<ref name="pmid23166211">{{cite journal |vauthors=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL |title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=126 |issue=25 |pages=e354–471 |date=December 2012 |pmid=23166211 |doi=10.1161/CIR.0b013e318277d6a0 |url=}}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |Sudden (acute)
| |
| | style="background: #F5F5F5; padding: 5px;" |2-10 minutes
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Heaviness/pressure/ tightness/squeezing/ burning ([[Levine's sign]])
| |
| *Retrosternal or left sided chest pain
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | +/-
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *[[Nausea and vomiting|Nausea]] and [[vomiting]]
| |
| *[[Diaphoresis]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Transient [[third heart sound]] [[S3|(S3]] - [[Ventricular|ventricular filling sound]]) and [[fourth heart sound]] ([[S4]] - [[atrial]] filling sound)
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Cardiac enzymes normal
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Exercise EKG: ST-segment depression
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Exercise Stress Testing: Decreased myocardial perfusion
| |
| *Transthoracic echocardiography: Ejection fraction <50 percent
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Coronary angiography
| |
| |- style="background: #DCDCDC; padding: 5px;" |
| |
| |
| |
| !'''[[Unstable Angina]]'''<ref name="pmid8998090">{{cite journal |vauthors=Tatum JL, Jesse RL, Kontos MC, Nicholson CS, Schmidt KL, Roberts CS, Ornato JP |title=Comprehensive strategy for the evaluation and triage of the chest pain patient |journal=Ann Emerg Med |volume=29 |issue=1 |pages=116–25 |date=January 1997 |pmid=8998090 |doi= |url=}}</ref><ref name="pmid10492848">{{cite journal |vauthors=Ornato JP |title=Chest pain emergency centers: improving acute myocardial infarction care |journal=Clin Cardiol |volume=22 |issue=8 Suppl |pages=IV3–9 |date=August 1999 |pmid=10492848 |doi= |url=}}</ref><ref name="pmid7611601">{{cite journal |vauthors=Gibler WB |title=Evaluation of chest pain in the emergency department |journal=Ann. Intern. Med. |volume=123 |issue=4 |pages=315; author reply 317–8 |date=August 1995 |pmid=7611601 |doi= |url=}}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |Acute
| |
| | style="background: #F5F5F5; padding: 5px;" |10-20 minutes
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Same as stable angina but often more severe
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | +
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *[[Nausea and vomiting]]
| |
| *[[Diaphoresis]]
| |
| *[[Presyncope]]
| |
| *[[Palpitation|Palpitations]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Reverse [[Splitting of S2|splitting]] of the [[second heart sound]]
| |
| *[[Rales/Crackles|Rales or crackles]]
| |
| *[[Elevated jugular venous pressure]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *[[Cardiac Biomarkers|Cardiac biomarkers [Cardiac troponin I, cardiac troponin T]] and [[CK MB|<nowiki>MB isoenzyme of creatine kinase (CK-MB)]</nowiki>]] normal
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *ST-depression
| |
| *New T wave inversions
| |
| *Transient ST-elevation
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Echocardiography: Ejection fraction <50 percent
| |
| *Exercise Stress Testing: Decreased myocardial perfusion
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Invasive coronary angiography
| |
| |- style="background: #DCDCDC; padding: 5px;" |
| |
| |
| |
| !'''[[Myocardial Infarction]]'''<ref name="pmid8704488">{{cite journal |vauthors=Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K |title=Chest pain in family practice. Diagnosis and long-term outcome in a community setting |journal=Can Fam Physician |volume=42 |issue= |pages=1122–8 |date=June 1996 |pmid=8704488 |pmc=2146490 |doi= |url=}}</ref><ref name="pmid8163958">{{cite journal |vauthors=Klinkman MS, Stevens D, Gorenflo DW |title=Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network |journal=J Fam Pract |volume=38 |issue=4 |pages=345–52 |date=April 1994 |pmid=8163958 |doi= |url=}}</ref><ref name="pmid19883149">{{cite journal |vauthors=Bösner S, Becker A, Haasenritter J, Abu Hani M, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Seitz G, Baum E, Donner-Banzhoff N |title=Chest pain in primary care: epidemiology and pre-work-up probabilities |journal=Eur J Gen Pract |volume=15 |issue=3 |pages=141–6 |date= 2009 |pmid=19883149 |doi=10.3109/13814780903329528 |url=}}</ref><ref name="pmid21391528">{{cite journal |vauthors=Ebell MH |title=Evaluation of chest pain in primary care patients |journal=Am Fam Physician |volume=83 |issue=5 |pages=603–5 |date=March 2011 |pmid=21391528 |doi= |url=}}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |Acute
| |
| | style="background: #F5F5F5; padding: 5px;" |Commonly > 20 minutes
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Same as stable angina but often more severe
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | +
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *[[Nausea and vomiting]]
| |
| *[[Diaphoresis]]
| |
| *[[Presyncope]]
| |
| *[[Palpitation|Palpitations]]
| |
| *[[Lateral]] [[displacement]] of the [[apical impulse]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Hypotension
| |
| * Tachycardia
| |
|
| |
|
| *[[S4]] [[Gallop rhythm|gallop]] | | *Bullet<ref name="pmid26678235">{{cite journal |vauthors=Yeh TK, Yeh J |title=Chest Pain in Pediatrics |journal=Pediatr Ann |volume=44 |issue=12 |pages=e274–8 |date=December 2015 |pmid=26678235 |doi=10.3928/00904481-20151110-01 |url=}}</ref> |
| *[[Paradoxical splitting of S2]]
| | **SUbbllet |
| *[[Mitral regurgitation]] [[Heart murmur|murmur]]
| | |
| | style="background: #F5F5F5; padding: 5px;" |
| | |
| *Elevated [[cardiac enzymes]]
| | ==References== |
| *↑[[Brain natriuretic peptide|B-Type Natriuretic Peptide]]
| | {{Reflist|2}} |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *ST elevation MI (STEMI)
| |
| *Non-ST elevation MI (NSTEMI) or Non Q wave
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Echocardiography: ↓ EF
| |
| *CCTA: Coronory artery stenosis
| |
| *CMRI: Coronory vessels stenosis
| |
| *MPI on SPECT or PET scanning: Decreased myocardial perfusion.
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *CCTA combined with MPI
| |
| |- style="background: #DCDCDC; padding: 5px;" |
| |
| ! rowspan="9" |Cardiac
| |
| !Vasospastic/ Prinzmetal/ Variant Angina<ref name="pmid14434946">{{cite journal |vauthors=PRINZMETAL M, KENNAMER R, MERLISS R, WADA T, BOR N |title=Angina pectoris. I. A variant form of angina pectoris; preliminary report |journal=Am. J. Med. |volume=27 |issue= |pages=375–88 |date=September 1959 |pmid=14434946 |doi= |url=}}</ref><ref name="pmid3779913">{{cite journal |vauthors=Kaski JC, Crea F, Meran D, Rodriguez L, Araujo L, Chierchia S, Davies G, Maseri A |title=Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina |journal=Circulation |volume=74 |issue=6 |pages=1255–65 |date=December 1986 |pmid=3779913 |doi= |url=}}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |Gradual in onset and offset
| |
| | style="background: #F5F5F5; padding: 5px;" |Episodic, gradual in onset and offset.
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Chest discomfort described as squeezing, tightness, pressure, constriction, strangling, burning, heart burn, fullness in the chest, a band-like sensation, knot in the center of the chest, lump in the throat, ache, and heavy weight on chest
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | +
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Nausea, sweating, dizziness, dyspnea, and palpitations
| |
| * Associated with other vasospastic disorders, such as Raynaud's phenomenon and migraine headache
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Multiple drugs (ephedrine-based products, cocaine, marijuana, alcohol, butane, sumatriptan, and amphetamines)
| |
| * Food-born botulism
| |
| * Guide wire or balloon dilatation while doing PCI
| |
| * Magnesium deficiency
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Tachycardia, hypertension, diaphoresis, and a gallop rhythm
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Urine drug screen may be positive for cocaine or other drugs
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Transient (less than 15 minutes) ischemic ST changes in multiple leads
| |
| * A tall and broad R wave,
| |
| * Disappearance of the S wave
| |
| * A taller T wave
| |
| * Negative U waves
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Stress testing: normal noninvasive stress test, exercise-induced spasm with ST-segment elevation,
| |
| * Stress echocardiography with ergonovine provocation: Vasospasm of coronory vessels
| |
| * Coronary arteriography: Epicardial spasm
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Coronary arteriography
| |
| |- style="background: #DCDCDC; padding: 5px;" |
| |
| !'''[[Aortic Dissection]]'''<ref name="pmid28847596">{{cite journal |vauthors=Takagi H, Ando T, Umemoto T |title=Meta-Analysis of Circadian Variation in the Onset of Acute Aortic Dissection |journal=Am. J. Cardiol. |volume=120 |issue=9 |pages=1662–1666 |date=November 2017 |pmid=28847596 |doi=10.1016/j.amjcard.2017.07.067 |url=}}</ref><ref name="pmid11922269">{{cite journal |vauthors=Kojima S, Sumiyoshi M, Nakata Y, Daida H |title=Triggers and circadian distribution of the onset of acute aortic dissection |journal=Circ. J. |volume=66 |issue=3 |pages=232–5 |date=March 2002 |pmid=11922269 |doi= |url=}}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |Sudden severe progressive pain (common) or chronic (rare)
| |
| | style="background: #F5F5F5; padding: 5px;" |Variable
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Tearing, ripping sensation, knife like
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | +
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *[[Focal neurologic deficit]]
| |
| *[[Hypotension]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Hypertension
| |
| * Genetically mediated collagen disorders
| |
| * Preexisting aortic aneurysm | |
| * Bicuspid aortic valve | |
| * Aortic coarctation
| |
| * Turner syndrome
| |
| * Vasculitis (giant cell arteritis, Takayasu arteritis, rheumatoid arthritis, syphilitic aortitis)
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *[[Pulse]] deficit
| |
| *New [[Diastolic murmurs|diastolic murmur]]
| |
| *[[Diastolic]] decrescendo [[Heart murmur|murmur]]
| |
| *[[Focal neurologic deficit]]
| |
| *[[Hypotension]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * [[D-dimer]] <500 ng/mL rules out aortic dissection
| |
| * ↑Soluble ST2 (sST2)
| |
| * Measurements of soluble elastin fragments, smooth muscle myosin heavy chain, high-sensitivity [[C-reactive protein (CRP)|C-reactive protein]], [[fibrinogen]], and [[Fibrillin|fibrillin fragments]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Nonspecific ST and T wave changes
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *CXR: Mediastinal and/or aortic widening
| |
| *CTA: A compressed true lumen
| |
| *MRA: Detects differential flow between the true and false lumens, widening of the aorta with a thickened wall
| |
| *TEE: Intimal dissection flaps, true and false lumens, thrombosis in the false lumen
| |
| *Aortography: Distortion of the normal contrast column, Flow reversal or stasis into a false channel, Failure of major branches to fill, and Aortic valvular regurgitation
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *CT angiography
| |
| *Digital subtraction aortography (if high suspicion)
| |
| |- style="background: #DCDCDC; padding: 5px;" |
| |
| !'''[[Pericarditis]]'''<ref name="pmid15028364">{{cite journal |vauthors=Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R |title=Day-hospital treatment of acute pericarditis: a management program for outpatient therapy |journal=J. Am. Coll. Cardiol. |volume=43 |issue=6 |pages=1042–6 |date=March 2004 |pmid=15028364 |doi=10.1016/j.jacc.2003.09.055 |url=}}</ref><ref name="pmid15001332">{{cite journal |vauthors=Troughton RW, Asher CR, Klein AL |title=Pericarditis |journal=Lancet |volume=363 |issue=9410 |pages=717–27 |date=February 2004 |pmid=15001332 |doi=10.1016/S0140-6736(04)15648-1 |url=}}</ref><ref name="pmid12622586">{{cite journal |vauthors=Spodick DH |title=Acute pericarditis: current concepts and practice |journal=JAMA |volume=289 |issue=9 |pages=1150–3 |date=March 2003 |pmid=12622586 |doi= |url=}}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |Acute or subacute
| |
| | style="background: #F5F5F5; padding: 5px;" |May last for hours to days
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Sharp & localized retrosternal pain
| |
| | style="background: #F5F5F5; padding: 5px;" | +
| |
| | style="background: #F5F5F5; padding: 5px;" | +
| |
| | style="background: #F5F5F5; padding: 5px;" | +
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *[[Pericardial friction rub]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *HIV
| |
| *TB
| |
| *Immunosuppression
| |
| *Acute trauma
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *[[Pericardial friction rub]] heard with the [[diaphragm]] of [[stethoscope]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Leukocytosis
| |
| *↑[[Cardiac troponin I (cTnI) and T (cTnT)|Troponin level]]
| |
| *↑[[Erythrocyte sedimentation rate]]
| |
| *↑[[C-reactive protein|C-reactive protein level]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *EKG changes (typically widespread ST segment elevation or PR depressions)
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Chest x-ray typically normal
| |
| *Echocardiogram: normal or pericardial effusion
| |
| *CT scan: Noncalcified pericardial thickening with pericardial effusion
| |
| *CMR: inflamed pericardium and myocarditis
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| *Pericardiocentesis
| |
| *Pericardial biopsy
| |
| |- style="background: #DCDCDC; padding: 5px;" |
| |
| |}
| |
| <references />
| |