Med-Spot on Med-Source - Differential Diagnosis: Chest Pain
Med-Spot on Med-Source 6.13.07 - Differential Diagnosis: Chest Pain, the Quick & Dirty
Because half of your service will be ROMIs you should commit this list to memorization ... or at least keep it handy.
- cardiac
- angina - radiating SSCP +/- diaphoresis, N/V, dyspnea, relieved by nitro or rest, get an EKG
- MI - angina > 30 min, get and EKG & enzymes (trop, CK)
- pericarditis - sharp pleuritic pain, relieved w. leaning forward, +/- friction rub, get an EKG (look for diffuse concave ST ↑)
- aortic dissection - tearing SSCP, asymmetric bp, get a CXR (widened mediastinum)
- pulomonary
- pneumonia (PNA) - pleuritic pain, dyspnea, productive cough, fever, get a CXR
- pleuritis - sharp pleuritic pain +/- friction rub
- pneumothorax - unilateral acute pleuritic, ↓BS, get a CXR
- PE - sudden pleuritic, tachypnea, tachycardia, hypoxemia, get a PE protocol CT &/or V/Q scan
- pulm. HTN - dyspnea, exertional pressure, hypoxemia, loud P2, get a CXR, ECHO
- GI
- esophageal reflux - worse w. food, relieved w. antacids, pH probe, EGD
- esophageal spasm - substernal pain worse w. swallowing, relieved by nitro/CCB, get an upper GI or manometry
- mallory-weiss tear - vomiting, get an EGD
- peptic ulcer dz (PUD) - epigastric pain better w. antacids, get an EGD +/- H.pylori
- billiary dz - RUQ pain, worse s/p fatty foods, get a RUQ u/s & LFTs
- pancreatitis - epigastric / back pain, elevated amylase & lipase, get an abd. CT
- musculoskeletal
- costochondritis - reproducible w. palpation
- c-spine dz / OA - precipitated by motion, get x-rays
- anxiety
- zoster - don't forget to actually look at your patient's chest
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