Interpret from symptoms and radiographic appearance if pain. In brief, common causes of dyspnea and pleuritic chest pain are pneumonia, pe. Evaluation of the adult with chest pain in the emergency. It usually occurs due to visceral and parietal pleura rubbing over each other but can be due to musculoskeletal or nerverelated pathology. According to the national health statistics reports on ambulatory medical care utilization estimates for 2006, 9 million patients had a complaint of chest pain and more than 2. Jun 24, 2014 chest pain with nausea and vomiting, marked sweating andor breathlessness, or haemodynamic instability. The differential diagnosis of chest pain sciencedirect.
This refers to chest pain that is not sharp and is not the patients familiar angina. Bloating is also related to increases in sick days. Pleuritic chest pain refers to pain felt worse on inspiration. Nice chest pain guideline nice guideline guidelines. The presence of any of these circumstances preceding an attack of severe anterior chest pain bears consideration in differential diagnosis. Because acute chest pain, depending on its etiology, may be associated with a high risk of death, rapid, goaloriented management is mandatory. Differential diagnosis for the advanced practice nurse. Full text is available as a scanned copy of the original print version. Differential diagnosis of chest pain by dr farooq on 29 0230 h. Epidemiology of chest pain reflects selection bias. The differential diagnosis of chest pain syndrome is broad and disparate, including disease processes that range from nonurgent to life threatening. It may be sharp, stabbing and pleuritic or oppressive and squeezing.
It is a serious concern for patients and practitioners because of its potentially lifethreatening implications. Noncardiac causes are common, but it is important not to overlook serious conditions such as an acute coronary syndrome, pulmonary embolism, or pneumonia. Abc of emergency differential diagnosis pdf free download. Differential diagnosis for metatarsal region pain radiology. Many clinicians do not want to evaluate chest pain. Table 1 cardiology causes of chest pain 3 assessment of. Oza, md, mph, the ohio state university, columbus, ohio. Relate the three types of nerve fibers found in pulp and how their responses are critical in diagnosing pain 4. A 46yearold woman with endstage renal disease, hypertension, diabetes, and tobacco use presents with dull, aching, substernal chest pain radiating to her arms. The differential diagnosis of painful thyroid disorders article pdf available in anaesthesia, pain and intensive care 122.
A patient with chest pain poses one of the most complicated diagnostic challenges. Mi myocardial infarction occurs when blood supply to the myocardium via coronary. Diagnosing the cause of chest pain american family physician. Retrosternal pain, may radiate to the arms, back, neck, or the lower jaw. The younger the patient, the more likely an organic etiology will be found although there is. It will become an increasingly common problem because the elderly population in the united states is growing rapidly. Chest pain may also vary from person to person based upon age, sex, weight, and other differences. The purpose of this article is to discuss the diagnosis, treatment, and management of the common causes of chest pain that can present in a young adult. Use nitroglycerin if you have had chest pain before or know that you have coronary heart disease, your clinician may prescribe nitroglycerin.
Churchills pocketbook of differential diagnosis pdf 4th. Discriminate pertinent diagnostic points during the subjective data collection when interviewing and assessing the chest pain patient 2. White massachusetts general hospital the differential diagnosis of chest pain pain in the chest may be a manifestation of many widely differing disease processes. Differential diagnosis of abdominal pain anatomic approach anatomic structure diagnosis.
Pdf angiosarcoma is the most common primary cardiac malignancy with a poor prognosis. Differential diagnosis of chest pain pain is a common health condition, and is usually temporary in nature. Common and important causes of chest pain for doctors and medical students. Despite much concern that underlying cardiac pathology is at play, the percentage of pain attributed to a cardiac etiology is low with an incidence of less than 5%. Chapter 53 approach to the patient with chest pain. Assessment of chest pain differential diagnosis of symptoms. There is pain on movement, stiffness and deformity. Causes and diagnosis of chest pain in young females. However, diagnosis can be difficult because the pain usually appears before the characteristic rash.
Chest pain is one of the common complaints heard in medical opds as well as at the gps clinic. Chest pain harrisons manual of medicine, 20e accessmedicine. Pdf approach to chest pain and acute myocardial infarction. Coronary heart disease is the cause in up to 25% of cases. No responsibility is assumed for damages or liabilities arising from accuracy, content error, or omission. Outpatient diagnosis of acute chest pain in adults john r. There are several lifethreatening causes of chest pain which need to be evaluated for first, which include. Chest pain is a frequent complaint of patients seeking urgent medical assistance. The interdisciplinary management of acute chest pain. Exclude a diagnosis of stable angina if clinical assessment indicates nonanginal chest pain and there are no other aspects of the history or risk factors raising clinical suspicion. Bates guide to physical examination and history taking 11th ed. Though bloating is typically not as serious as abdominal pain from the physicians perspective, patients often report significant difficulties due to bloating in terms of their ability to work and participate in social or recreational activities. It is the presenting complaint in 1% of clinicbased visits.
Ideally, the detailed history is taken where resuscitation facilities are available. Differential diagnosis pleuritic chest pain has many etiologies. Evaluation of chest pain in 2019 american college of physicians. Some patients presenting with chest pain will have serious acute illness with a high short. Idiopathic chest pain spinal cord compression tumor. Duration usually over 20 minutes pain is continuous, and its intensity does not alter but may get worse. Symptoms of rheumatoid arthritis may be present elsewhere. Cause grouping differentials classical history classic examination findings investigation findings. Chest pain knowledge for medical students and physicians. Chest pain radiating to the left arm mi chest pain worse with movement musculoskeletal pain benefits.
Start studying differential diagnosis chest pain questions. Nitroglycerin is a small pill that is placed under the tongue if chest pain occurs. This article throws light on some possible diagnosis. Assessment of chest pain differentials bmj best practice. Forefoot pain in the metatarsal region is a common complaint and may be caused by a number of conditions. Chest pain pediatrics clerkship the university of chicago. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Differential diagnosis of chest pain is generated almost entirely by history, with some addition of exg, chest xray, and specific laboratory exams. Pdf echocardiography in differential diagnosis of chest pain and. Alright, so when youre presented with chest symptoms as mentioned above, you have to immediately ask, who is your pappa. Although the differential diagnosis of chest pain is exhaustive, chest pain in children is least likely to be cardiac in.
The differential diagnosis of chest pain is shown in figs. Common and important causes of chest pain for doctors. Chest pain may present in different ways depending upon the underlying diagnosis. Chestpain general presentation in children and adolescents, chest pain is a commonly encountered problem. Jul 17, 2018 the evaluation of elderly patients presenting with abdominal pain poses a difficult challenge for the emergency physician. Differential diagnosis is a process health care providers use to come to a definitive diagnosis, often by eliminating all other possible diseases and conditions. Abc of emergency differential diagnosis pdf free download section.
Chest pain is a high risk chief complaint current consensus is to exclude lifethreatening causes of chest pain to less than 1% uncertainty 99% npv, do it costeffectively, efficiently and noninvasively when possible. Clinical diagnosis uss abdopelvis if gynae differentials inflammatory markers. 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. The typicality of chest pain can be categorised as follows. Nov 06, 2015 acute chest pain of nontraumatic origin is a common reason for presentation to physicians offices and emergency rooms. Pappa is one the best mnemonics to help memorize chest pain differential diagnosis ddx. Chest pain is something that cannot be neglected under any circumstances whatsoever. Chest pain is a common reason parents seek medical attention for their children. The role of conventional chest radiography in the diagnosis of acute respiratory failure in the emergency department poster no c2021. Abdominal pain in elderly persons differential diagnoses. The cause etiology of chest pain varies according to age, sex, risk factors, type of symptoms etc. Patients may call chest symptoms pressure, discomfort, tightness, funny feeling, etc.
Differential diagnosis of chest pain sciencedirect. Andrea efre healthcare education consultants 05122016 page 1 references for the presentation. Nov 05, 2018 found to have multiple pulmonary nodules suggestive of metastasis with the largest being a subpleural nodule in the superioranterior portion of the rul roughly the location of the patients pain. In the uk, 1% to 2% of adults attend primary care each year with a new presentation of chest pain.
The differential diagnosis of chest pain request pdf. Consideration needs to be given to the structures from the skin to the internal organs. Its fast, the common things usually come to mind, and it is how most clinicians think. Differential diagnosis chest pain questions flashcards.
Chest pain is a common pediatric complaint with the average presenting age of 12. Traumatic causes of chest pain are not addressed here. We report the case of a hodgkins lymphoma presenting as chest pain due to the presence of multiple lymphoade nopathies of the superior mediastinum and a polylobated mass in the middle lobe of the right lung. There are many causes of chest pain as outlined in table 1 but acute coronary syndrome is one of the potentially more serious causes that require rapid identification and implementation of treatment in an attempt to preserve myocardial function and pre. Jun 23, 2010 differential diagnosis of chest pain by dr farooq on 29 0230 h. This section of the guideline addresses the assessment and diagnosis of intermittent stable chest pain in people with suspected stable angina. Evaluation of chest pain differential diagnosis of symptoms. Gout may present with pain and swelling of the knee.
Differential diagnosis for pleuritic chest pain oxford. Get a printable copy pdf file of the complete article 1. 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. Once lifethreatening causes have been ruled out either by patient history, examination, or rapid diagnostics, a more thorough history and examination should be performed to narrow the differential diagnosis and guide further diagnostic workup and therapy. Churchills pocketbook of differential diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of the clinical approach to the field. The main feature of myocardial ischemia impending infarction is usually prolonged chest pain. Additionally, patients who complain of chest pain wont always have the expected signs and symptoms. 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 is one of the most common reasons that patients present to the emergency department. Newonset chest pain, or abrupt deterioration in stable angina, with recurrent pain occurring frequently with little or no exertion and often lasting longer than 15 minutes. Differential dx strategies university of massachusetts. Colicky abdominal pain no bowel motions or flatus distended, tender abdomen tinkling bowel sounds. Thinking through the differential diagnosis boerhaave syndrome is a transmural perforation of the esophagus to be distinguished from malloryweiss syndrome, a nontransmural esophageal tear also associated with vomiting. It is helpful to use a clinical approach that aids physicians in immediately distinguishing between six lifethreatening causes of.
Jan 14, 2020 chronic pain syndrome cps is a common problem that presents a major challenge to healthcare providers because of its complex natural history, unclear etiology, and poor response to therapy. Acute chest pain of nontraumatic origin is a common reason for presentation to physicians offices and emergency rooms. Chest pain may present as a stabbing, burning, aching, sharp, or pressurelike sensation in the chest. Differential diagnosis for chest pain oxford medical education. Differential diagnosis for chest pain oxford medical. Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the us per year. Chest pain is one of the most frequent reasons why people visit the emergency department. This new title in the abc series covers the assessment, diagnosis, treatment, and management of the most common symptoms with. Chest pain differential diagnosis linkedin slideshare. The causes of chest pain, from benign to lifethreatening, have overlapping symptoms.
Diagnostic ap proach and differential diagnosis are discussed. The underlying disease processes can range from benign to lifethreatening. Chest pain is pain or discomfort in the chest, typically the front of the chest. It is the presenting complaint in 1% of officebased visits. Each of these features can help focus the differential diagnosis see figure 151, table 151. Evaluation of chest pain differential diagnosis of.
This is especially relevant when a patient presents with chest pain, where differentiation of the type of pain and its likely cause is crucial. However, when we speak of chest pain, the reason behind the same need not be something temporary. Pdf low back pain is a symptom affecting millions of adults annually. 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. 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. Making a differential diagnosis of chest pain is very extensive because so many different factors can cause this. You will not miss any highrisk causes if you remember this. Pdf the differential diagnosis of painful thyroid disorders. Causes and diagnosis of chest pain in young females doctors. Chest pain covered extensively in chapter 9 is another pivotal clue in patients with dyspnea. The quote listen to your patient, he is telling you the diagnosis is attributed to the canadian physician william osler. Life threatening differential chest pain diagnoses supplemental guide the north dakota department of health is not responsible for inaccuracies contained herein. Explain the value of a cardiovascular history, the value and limitations of ecg, troponin, and other point of care diagnostics relate how to develop a differential diagnosis for a patient presenting with chest pain.
Chest pain differential diagnosis free questions and answers for doctors and medical student. In addition to a thorough history and physical examination, most patients should have a chest radiograph and an electrocardiogram. The younger the patient, the more likely an organic etiology will be found although there is rarely a serious underlying disease. Chest pain may be caused by either benign or lifethreatening etiologies and is usually divided into cardiac. Chest pain may be pleuritic or nonpleuritic and acute or chronicrecurrent. Common and important causes of pleuritic chest pain for doctors and medical students. Although the differential diagnosis of chest pain is exhaustive, chest pain in. 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. Differential diagnosis for metatarsal region pain dr henry knipe and dr andrew dixon et al. Furthermore, within the consideration of lifethreatening causes, patients may be suffering from coronary causes, as well as pulmonary embolism, aortic dissection, aortic rupture, pneumothorax, or even esophageal rupture. The differential diagnosis of chest pain is best remembered using an anatomic approach. Lifethreatening conditions patients in whom there is concern for lifethreatening condition should be referred to the emergency department by ambulance. Also, the abc of emergency differential diagnosis pdf free download file is on an online repository for the safer downloading of the file. A differential diagnosis of acute chest pain drbeen.