14. COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN Characteristic M.I. Pericarditis G.I. Prob Angina Dis. Aneurysm P. Embolism Onset Gradual/ Sudden Sudden Gradual/ Sudden Gradual/ Sudden Abrupt Gradual/ Sudden Precipitating Factors At rest / after exercise or emotional stress Breathing deeply, rotating trunk, yawning Inflammation of GI parts; increased HCL; medications After exercise, emotional stress, eating, envt’l changes Hypertension Immobility, Prolonged bedrest Location Substernal, anterior chest, rarely back, radiates to jaw/neck Precordial; rotates to neck/ left shoulder & arm Xiphoid to umbilicus Substernal, anterior chest; poorly localized Site of rupture; anterior chest or back; between scapula Pleural area, retrosternal Quality Crushing, burning, stabbing, squeezing, vicelike Pleuritic, sharp Aching, burning, cramplike, gnawing Squeezing, feeling of heavy pressure; burning Sharp, tearing, ripping Sharp, stabbing
15. COMPARISON OF PHYSICAL CAUSES OF CHEST PAIN Characteristic M.I. Pericarditis G.I. Prob Angina Dis. Aneurysm P. Embolism Intensity Asymptomatic to severe; increases with time Mild to severe Mild to severe Mild to moderate Severe, unbearable; maximal from onset Aggravated by breathing Duration 30 min to 1-2 hours; may wax and wane Continuous Periodic 2-10 min; ave: 3-5 min Continuous; does not abate once started Variable Relief Narcotics Sitting up, leaning forward Physical/ emotional rest, food, antacid Nitroglycerin, rest Large, repeated doses of narcotics 0 2 , sitting up; morphine Associated Symptoms Nausea, fatigue, heartburn, equal peripheral pulses Fever, dyspnea, nausea, anorexia, anxiety N/V, dysphagia, anorexia, weight loss Belching, indigestion, dizziness Syncope, loss of sensations / pulses, oliguria, BP discrepancies, decrease in pulses Dyspnea, tachypnea, diaphoresis, hemoptysis, cough, apprehension
49. Left Ventricular Compared with Right Ventricular Heart Failure LEFT VENTRICULAR FAILURE RIGHT VENTRICULAR FAILURE Pulmonary crackles Jugular venous distention Tachypnea Peripheral edema S 3 gallop Perioral and peripheral cyanosis Cardiac murmurs Congestive hepatomegaly Paradoxical splitting of S 2 Ascites Hepatojugular reflux
