Women often have symptoms of fatigue, tiredness, or sleep disturbances as prodromal symptoms before a cardiac event. Get a printable copy pdf file of the complete article 1. Feels like pressure, squeezing, burning, or strangling. Also, the abc of emergency differential diagnosis pdf free download file is on an online repository for the safer downloading of the file. For this reason, in general, additional tests are required to establish the diagnosis. Outpatient diagnosis of acute chest pain in adults. 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. Pulmonary tuberculosis must be differentiated from other diseases that cause cough, fever, night sweats, hemoptysis and weight loss, such as.
An expert algorithm to assist in the diagnosis of chest pain can be found here to go back to the main page on unstable angina, click here overview. 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. Differential diagnosis of low back pain article pdf available in seminars in pain medicine 23. The differential diagnosis of chest pain syndrome is broad and disparate, including disease processes that range from nonurgent to life threatening. Diagnosing the cause of chest pain american family physician. It is the presenting complaint in 1% of officebased visits.
Chest pain is a common pediatric complaint with the average presenting age of 12. Nontraumatic chest pain is one of the most common causes of emergency department visits and is common in both inpatients and outpatients. Feels like tightness or heaviness, a band across the chest. Pulnonary tuberculosis must be differentiated from other cavitary lung lesions. A patient with chest pain poses one of the most complicated diagnostic challenges. Chest pain is a common reason parents seek medical attention for their children. There are several lifethreatening causes of chest pain which need to be evaluated for first, which include. The differential diagnosis of chest pain sciencedirect. Outpatient diagnosis of acute chest pain in adults american. Differential diagnosis of chest pain sciencedirect. Full text full text is available as a scanned copy of the original print version. At those times adding a different strategy often reveals more conditions. Evaluation of chest pain differential diagnosis of symptoms.
Common and important causes of chest pain for doctors. Chest pain syndrome is inclusive of symptoms that may be caused by acute myocardial ischemia and includes such diverse complaints as chest pain, chest. However, when we speak of chest pain, the reason behind the same need not be something temporary. 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. Oct 23, 2018 pocket manual of differential diagnosis, 5th ed. Chest pain covered extensively in chapter 9 is another pivotal clue in patients with dyspnea.
Chest pain that radiates to the back, jaw, left arm or left shoulder. Prevalence of lifethreatening diagnoses in patients with. It may be described as sharp, dull, pressure, heaviness or squeezing. Of all patients presenting to primary care with chest pain 12% of all consultations, around 15% are thought to be nonspecific i. 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. Table 1 lists the differential diagnosis of chest pain. A headache, like a chest pain or back ache, has many causes. Start studying differential diagnosis chest pain questions. Key points sternoclavicular joint septic arthritis is a rare condition that accounts for 1% of all bone and joint infections in the general population. The younger the patient, the more likely an organic etiology will be found although there is rarely a serious underlying disease. In the uk, 1% to 2% of adults attend primary care each year with a new presentation of chest pain.
Chest pain pediatrics clerkship the university of chicago. Causes and diagnosis of chest pain in young females. Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes. Differential diagnosis for chest pain oxford medical. 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. Common and important causes of chest pain for doctors and medical students. Practice this using a number of strategies with a few different complaints. Even then, there are lots of young to middle aged, menstruating women complaining of chest pain and quite distressed about it. Sections of the guide line were developed for use by patients and their. 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.
Consequently, patients presenting with a complaint of chest pain frequently require serial evaluations, and admission to an observation unit or the hospital. Abnormal findings may be noted on routine chest xray examination on admission to general hospitals. Chest pain may be caused by either benign or lifethreatening etiologies and is usually divided into cardiac. These volumes are intended to be summaries of conferences with paneltype discussions and presentations designed to make available the. The differential diagnosis of chest pain request pdf. Assessment of chest pain differential diagnosis of symptoms bmj. This article describes the causes, assessment and differential diagnosis of musculoskeletal chest wall pain, and the management of its most common causes. White massachusetts general hospital the differential diagnosis of chest pain pain in the chest may be a manifestation of many widely differing disease processes. Sep 01, 2018 hollander je, hoffman rs, gennis p, et al. Chest pain is a common presenting complaint in many healthcare settings, including gi settings. Differential diagnosis of chest pain request pdf researchgate. Each of these features can help focus the differential diagnosis see figure 151, table 151. The younger the patient, the more likely an organic etiology will be found although there is. Aug 20, 2018 chest pain is a common reason parents seek medical attention for their children.
Differential diagnosis of chest pain pain is a common health condition, and is usually temporary in nature. A differential diagnosis of acute chest pain drbeen. It may be caused by a variety of cardiac and noncardiac abnormalities. Thus, this condition should be one of the important differential diagnoses to be excluded in patients with severe chest pain. Differential diagnosis for chest pain oxford medical education. Oshea and others published differential diagnosis of chest pain find, read and cite all the research you need on. Gender also plays a role in chest pain complaints, as mis are more common in men over the age of 40 and in women over the age of 50. Consider their risk factors and apply clinical decision rules to exclude a pe, before attributing symptoms to a musculoskeletal aetiology. Chest pain may be pleuritic or nonpleuritic and acute or chronicrecurrent. The differential diagnosis is broad and includes cardiac e. 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. This article will discuss the differential diagnosis of headaches, types of headaches, and when you should be really concerned about your headache.
It is a serious concern for patients and practitioners. Substernalleft sided chest pressure or tightness is common onset is gradual pain radiating to shoulders or pain with exertion increases relative risk atypical symptoms eg, dyspnea, weakness more common in elderly, women, diabetics. Video must be watched to completion to be eligible for full credit. Abc of emergency differential diagnosis pdf free download. Full text is available as a scanned copy of the original print version. Angina pectoris, chest pain, differential diagnosis, electrocardiography, medical history taking, physical examination, practice guidelines, symptoms. History of exertional chest pain or exertional syncope. In brief, common causes of dyspnea and pleuritic chest pain are pneumonia, pe. Request pdf the differential diagnosis of chest pain chest pain is a frequent complaint of patients seeking urgent medical assistance. This refers to chest pain that is not sharp and is not the patients familiar angina. This new title in the abc series covers the assessment, diagnosis, treatment, and management of the most common symptoms with. A pain in the head with the pain being above the eyes or the ears, behind the head occipital, or in the back of the upper neck.
Approach to undifferentiated chest pain in the emergency. Certain strategies work better for different symptoms. Remember that chest pain in women may vary significantly from men. Chest pain that is reproducible during the physical exam with contact of the chest wall is more indicative of noncardiac chest pain, but still cannot completely rule out acute coronary syndrome. It can be divided into heartrelated and nonheartrelated pain. Assessment of chest pain differential diagnosis of.
The problem of differential diagnosis of chest diseases may arise in medical practice in four ways. Differential diagnosis of chest discomfort and general approach to. 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. Chest pain differential diagnosis free questions and answers for doctors and medical student.
In rosens emergency medicine concepts and clinical practice 8th ed. Differential dx strategies university of massachusetts. D, is a practicing anesthesiologist at santa clara valley medical. If a patient has chest pain, a possible lifethreatening differential diagnosis could be a pe. Once the clinical examination has narrowed the differential diagnosis, diagnostic testing helps determine whether the patient has a serious condition. A differential diagnosis of acute chest pain duration. 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. The initial pivotal points are the acuity of onset of the pain and the presence of vital sign abnormalities. Pain due to insufficient blood flow to the heart is also. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Nurses can play a critical role in the differential diagnosis of chest pain by obtaining a thorough. Outpatient diagnosis of acute chest pain in adults this is a corrected version of the article that appeared in print. Nov 15, 2005 once the clinical examination has narrowed the differential diagnosis, diagnostic testing helps determine whether the patient has a serious condition.
The differential diagnosis is extensive and includes diagnoses that can be. Jun 06, 2016 no more chest pain today is the 4th day, he is febrile 38 39c since 3rd day, esr and wbc is high, he suddenly complaining of severe sharp precordial pain, cannot breathin or cannot lie down. Chest pain differential diagnosis linkedin slideshare. Differential diagnosis chest pain questions flashcards. Pain of moderate severity, localized to the mid or upper sternal region, with or without radiation and not associ ated with appreciable weakness, must be differentiated from the more common causes of chest pain of this magnitude, namely, acute coronary failure, benign idiopathic pericarditis, pulmo nary embolism, spinal root compression and. It is the presenting complaint in 1% of clinicbased visits.
Prospective multicenter evaluation of cocaineassociated chest pain. Furthermore, within the consideration of lifethreatening causes, patients may be suffering from coronary causes, as well as pulmonary embolism. Chest pain is pain or discomfort in the chest, typically the front of the chest. Patients are seen by the physician because of symptoms referable to the chest. Assessment of chest pain differential diagnosis of symptoms. Associated symptoms may include pain in the shoulder, arm, upper abdomen or jaw or nausea, sweating or shortness of breath. After generating a differential, you may decide that you would like to expand upon it. Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the us per year. Ideally, the detailed history is taken where resuscitation facilities are available. Basem elsaid enany lecturer of cardiology ainshams university 2.
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. These volumes are intended to be summaries of conferences with paneltype discussions and presentations designed to make available the latest collective thinking on topics of. Evaluation of chest pain in 2019 american college of physicians. Differential diagnosis of headaches definition, types ddx.
32 393 1467 28 1630 1154 298 1110 54 1615 1262 1604 628 1537 533 480 1161 1453 503 1227 1305 615 656 302 1237 1305 1251 1578 153 891 1193 1636 62 1327 172 1547 852 722 863 305 562 1492 353 719 1465 870 691