“Differential diagnosis of chest pain” by Dr Muhammad Farooque presented on 29 02-30 h.
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“Differential diagnosis of chest pain” by Dr Muhammad Farooque presented on 29 02-30 h.
- 1. WELCOME TO CME CFH
- 2. IN THE NAME OF ALLAH THE MOST GRACIOUS,THE MOST MERCIFUL
- 4. DIFFERENTIAL DIAGNOSIS OF CHEST PAIN DR.MUHAMMAD FAROOQUE MB BS DTCD
- 9. PAIN JUST A CURSE OR A MERCY OF GOD
- 15. CHEST PAIN CLASSIFICATION FROM CLINICAL VIEW POINT: RECURRENT OFTEN PAROXYSMAL MILD OR MODERATE ANGINA MUSCULOSKELETAL PAINS SEVERE PROLONGED ASSOCIATED WITH CLINICAL EVIDENCE OF ACUTE SERIOUS ILLNESS 1 2
- 21. TIME IS VITAL
- 26. CARDIAC OR NON-CARDIAC PAIN?
- 31. Chest Pain: Location Myocardial ischemia Pericarditis Pleurisy, Sub-diap abscess Myocardial ischemia Cervical spine Thoracic outlet Pulmonary embolism Pneumonia Splenic infarction Subdiap. abscess Myocardial ischemia Pericarditis Aortic dissection Mediastinal lesion Pulmonary embolism Esophageal spasm Cholecystitis Hepatic distension Peptic disease Pancreatitis Myocardial ischemia
- 32. ISCHEMIC CARDIAC PAIN NON-CARDIAC PAIN V/S LOCATION CENTRAL, DIFFUSE PERIPHERAL LOCALIZED RADIATION JAW/NECK/SHOULDER/ OCCASIONALLY BACK OTHER OR NO RADIATION CHARACTER TIGHT SQUEEZING CHOKING SHARP STABBING CATCHING PRECIPITATION EXERTION EMOTION SPONTANEOUS NOT RELATED TO EXERTION PROVOKED BY POSTURE, RESPIRATION OR PALPATION RELIEVING FACTORS REST NITRATES NOT RELIEVED BY REST SLOW OR NO RESPONSE BY NITRATES ASSOCIATED FEATURES BREATHLESSNESS RESP; GIT,LOCOMOTOR, OR PSYCHOLOGICAL
- 33. MYOCARDIAL ISCHEMIA(ANGINA) MI MYOCARDITIS PERICARDITIS MVP AORTIC DISSECTION AORTIC ANEURYSM ESOPHAGITIS ESOPH SPASM MW SYNDROME BRONCHOSPASM:::::PE:::PI PNEUMONIA:::::TB:::::::CTDs TRACHEITIS PLEURITIS PNEUMOTHORAX MALIGNANCY OA RIB # I/C MUSCLE INJURY TEITZE`S SYND BORNHOLM`S DISEASE PROLAPSED I/V DISC HERPES ZOSTER THORACIC OUTLET SYNDROME
- 35. ISCHEMIC CARDIAC PAIN ORIGIN? SITE OF ORIGIN OF PAIN CENTRAL
- 52. Clinical Spectrum of Acute Coronary Syndromes None Positive Positive ECG early ST-segment depression and/or T-wave inversion ST-segment elevation ECG late No Q No Q Q develops Stable angina Unstable angina Non-STE MI STE MI Antman EM. In: Braunwald E, ed. Heart Disease: A Textbook in Cardiovascular Medicine , 5th ed. Philadelphia, Pa: WB Saunders; 1997. ST-segment depression and/or T-wave inversion Evidence of necrosis
- 58. ECG assessment ST Elevation or new LBBB STEMI Non-specific ECG Unstable Angina ST Depression or dynamic T wave inversions NSTEMI
- 59. Normal or non-diagnostic EKG
- 60. ST Depression or Dynamic T wave Inversions
- 62. New LBBB QRS > 0.12 sec L Axis deviation Prominent R wave V1-V3 Prominent S wave 1, aVL, V5-V6 with t-wave inversion
- 81. TB
- 93. PERICARDITIS ECG
- 100. PROLAPSED DISC
- 101. HERPES ZOSTER
- 102. THANK YOU
Notas del editor
- In spite of the many innovations over the years and the huge influx of technology into medicine and cardiology, the evaluation of acute chest pain remains an important and challenging task for the physician today. It leads to more than 5 million ER visits annually and more than 8 billion dollars in hospitalization costs each year. And while on one hand less than a third of patients with chest pain are found to have a cardiac etiology, a not insignificant number of patients discharged from the ED turn out to have unrecognized acute MI
- So our goal, then, is minimize the cost and hospitalization of patients with chest pain of benign etiology, but to rapidly and accurately recognize and treat those with true acute coronary syndromes.
- There are many ways chest pain can be approached, ranging from use of clinical clues, cookbook algorithms, computer guided algorithms, and finally, the use of dedicated chest pain centers. Each approach will now be reviewed.
- Lecture Notes On initial examination, Q-wave AMI may masquerade as another ACS (eg, unstable angina or non–Q-wave MI) or vice versa. Distinguishing AMI from another possible ACS is important as fibrinolytic therapy has not been proved beneficial for other forms of ACS and entails a bleeding risk.