Chest pain resident survival guide: Difference between revisions
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{{familytree | | | | | B01 | | | | | | | | | | | | B02 |B01=Presence of ST elevation|B02=Absence of ST elevation}} | {{familytree | | | | | B01 | | | | | | | | | | | | B02 |B01=Presence of ST elevation|B02=Absence of ST elevation}} | ||
{{familytree | | | | | |!| | | | | | | | | | | | | |!| | | | | | | | }} | {{familytree | | | | | |!| | | | | | | | | | | | | |!| | | | | | | | }} | ||
{{familytree | | | | | |!| | | | | | | | | | | | | B03 | | | | | | | B03= }} | {{familytree | | | | | |!| | | | | | | | | | | | | B03 | | | | | | | B03= Rule out life threatening conditions}} | ||
{{familytree | |,|-|-|-|+|-|-|-|.| | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | }} | {{familytree | |,|-|-|-|+|-|-|-|.| | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | }} | ||
{{familytree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | C01= | C02= | C03= | C04= | C05= | C06= | C07= }} | {{familytree | C01 | | C02 | | C03 | | |!| | | | | | | | | | | |!| | C01='''Does the patient have both of the following:'''<br> | ||
❑ There is ST elevation in a limited number of leads that fits the anatomic distribution of a coronary artery (examples would include but are not limited to leads 2,3,F, or Leads v1-v4)<br> | |||
❑ PR Depression is absent | |||
| C02= '''Does the patient have any of the following:''' <br> | |||
❑ There is ST elevation in multiple leads that does not follow an anatomic distribution of coronary arteries (ST elevation is diffuse)<br> | |||
❑ PR Depression is present <br> | |||
❑ PR elevation in lead aVR is present <br> | |||
| C03= ❑ Evidence of [[LBBB]]}} | |||
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | |||
{{familytree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | C01= [[STEMI]]| C02= [[Pericarditis]] | C03= [[LBBB]]| C04= [[Aortic dissection]]| C05= [[Pulmonary embolism]]| C06= [[Tension pneumothorax]]| C07= [[Esophageal rupture]]}} | |||
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | {{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | ||
{{familytree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | D01= | D02= | D03= | D04= | D05= | D06= | D07= }} | {{familytree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | D01= | D02= | D03= | D04= | D05= | D06= | D07= }} | ||
Revision as of 16:06, 28 February 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Definition
Chest pain is discomfort or pain that is felt anywhere along the front of the body between the neck and the upper abdomen.
Causes
Life-Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Aortic dissection
- Myocardial infarction
- Pericardial tamponade
- Pneumothorax
- Pulmonary embolism
- Unstable angina
Common Causes
- Biliary colic
- Costochondritis
- Cocaine induced coronary vasospasm
- Esophageal spasm
- GERD
- Myocardial infarction
- Panic attacks
- Pneumonia
- Stable angina
Management
Please find below an algorithm that summarizes the approach to chest pain.
| Assess EKG | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Presence of ST elevation | Absence of ST elevation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rule out life threatening conditions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Does the patient have both of the following: ❑ There is ST elevation in a limited number of leads that fits the anatomic distribution of a coronary artery (examples would include but are not limited to leads 2,3,F, or Leads v1-v4) | Does the patient have any of the following: ❑ There is ST elevation in multiple leads that does not follow an anatomic distribution of coronary arteries (ST elevation is diffuse) | ❑ Evidence of LBBB | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| STEMI | Pericarditis | LBBB | Aortic dissection | Pulmonary embolism | Tension pneumothorax | Esophageal rupture | |||||||||||||||||||||||||||||||||||||||||||||||||