| Differential Diagnosis
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History and Symptoms
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Physical Examination
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Laboratory Findings
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Imaging Findings
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- ST Segment Elevation Myocardial Infarction
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- Chest pain with possible radiation to left arm and lower jaw
- Squeezing, crushing chest pain
- Sweating
- Nausea and vomiting
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- Anxious patient in pain with diaphoresis
- Signs of heart failure may be present
- Arrhythmia
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- ST elevation, new left bundle branch block, and Q wave on EKG
- Elevated cardiac biomarkers
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- Either complete or subtotal occlusion of an epicardial coronary artery on coronary angiography
- Confluent hyperenhancement extending from the endocardium
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- Non ST Elevation Myocardial Infarction
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- Crushing, left-sided substernal chest pain or pressure that radiates to the neck or left arm
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- ST-segment depression or T-wave inversion on EKG
- Elevated cardiac biomarkers
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- Pericarditis
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- Chest pain relieved by sitting up and leaning forward and worsened by lying down
- Fever, anxiety, difficulty breathing
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- Pericardial friction rub
- Signs of cardiac tamponade may be present
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- PR segment depression and electrical alternans on EKG
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- A flask-shaped, enlarged cardiac silhouette on CXR
- Pericardial thickness of more than 4 mm on MRI
- Pericardial effusion and cardiac chamber indentation or collapse on echo when cardiac tamponade is present
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- Pulmonary Edema
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- Hemoptysis
- Difficulty breathing, wheezing
- Symptoms of fluid overload if pulmonary edema is chronic
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- Dyspnea, nasal flaring
- End-inspiratory crackles
- Third heart sound (S3)
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- Low oxygen saturation on ABG
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- Kerley B lines, increased vascular markings, interstitial edema, and peribronchial cuffing on CXR
- Patchy alveolar infiltrates on CXR in noncardiogenic edema
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- Alcoholic Cardiomyopathy
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- Middle-aged man with history of alcohol abuse and shortness of breath on activity
- Fatigue, weakness, anorexia, and palpitations
- Leg swelling and pedal edema
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- Unstable Angina
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