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= Rule out life threatening conditions}} | {{familytree | | | | | |!| | | | | | | | | | | | | B03 | | | | | | | B03=<div style="float: left; text-align: left; width: 15em; padding:1em;"> ❑ Rule out life threatening conditions </div>}} | ||
{{familytree | |,|-|-|-|+|-|-|-|.| | | |,|-|-|-| | {{familytree | |,|-|-|-|+|-|-|-|.| | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | }} | ||
{{familytree | C01 | | C02 | | C03 | | |!| | | | | | | | | | | |!| | C01='''Does the patient have both of the following:'''<br> | {{familytree | C01 | | C02 | | C03 | | |!| | | |!| | | |!| | | |!| | C01=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''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> | ❑ 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 | ❑ PR depression is absent </div> | ||
| C02= '''Does the patient have any of the following:''' <br> | | C02= <div style="float: left; text-align: left; width: 15em; padding:1em;"> '''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> | ❑ 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 Depression is present <br> | ||
❑ PR elevation in lead aVR is present < | ❑ PR elevation in lead aVR is present </div> | ||
| C03= ❑ Evidence of [[LBBB]]}} | | C03=<div style="float: left; text-align: left; width: 15em; padding:1em;"> ❑ Evidence of [[LBBB]] </div>}} | ||
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | {{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 | 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]]}} | ||
Revision as of 16:11, 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 | |||||||||||||||||||||||||||||||||||||||||||||||||