Common and important causes of pleuritic chest pain for doctors and medical students. The cause etiology of chest pain varies according to age, sex, risk factors, type of symptoms etc. Diagnosis of chest wall pain is given to a vast majority 1050% of all ed visits for chest pain. However, not all chest pain or discomfort is a sign of chd. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. Sudden onset of chest pain that is sharp in nature and may lead to feelings of tightness in the chest. A patient with chest pain poses one of the most complicated diagnostic challenges. Differential diagnosis of chest pain and diagnostic findings. Other conditions also can cause chest pain, such as. Diagnosing the cause of chest pain american family physician. The differential diagnosis is extensive and includes diagnoses that can be imminently lifethreatening. Churchills pocketbook of differential diagnosis pdf 4th.
In addition to boerhaaves syndrome, the differential diagnoses of chest and abdominal pain should include myocardial infarction, pulmonary embolism, aortic dissection, and pancreatitis. Traumatic causes of chest pain are not addressed here. Chest pain may be caused by either benign or lifethreatening etiologies and is usually divided into cardiac. It is the presenting complaint in 1% of clinicbased visits.
White massachusetts general hospital the differential diagnosis of chest pain pain in the chest may be a manifestation of many widely differing disease processes. Cause grouping differentials classical history classic examination findings investigation findings initial test, diagnostic test. Common and important causes of chest pain for doctors and medical students. Disorders with musculoskeletal chest pain as a clinical feature. At those times adding a different strategy often reveals more conditions. Diagnosis for chest pain as mentioned earlier, chest pain can lead to various causes and can be an indication to various health diseases. Differential diagnosis of common presentations oxford. Epidemiology of chest pain reflects selection bias. Differential diagnosis of chest pain sciencedirect. Shortness of breath hypotension, tracheal deviation and neck vein distention tachycardia tachypnea cough fatigue cyanosis diagnosis. It is helpful in excluding other diseases and establishing the presence of significant comorbidities such as cardiac failur e. Pdf shoulder pain is a common problem in outpatient medical practice. Other common diagnoses of abdominal pain in men and women are as follows. Nurses will play an increasing role in the differential diagnosis of chest pain and should be familiar with correct procedures and practice.
Decreased or absent breath sounds over the affected lung. The differential diagnosis of chest pain nursing times. Pappa is one the best mnemonics to help memorize chest pain differential diagnosis ddx. Ideally, the detailed history is taken where resuscitation facilities are available. Although the differential diagnosis of chest pain is exhaustive, chest pain in children is least likely to be cardiac in origin. Patients may call chest symptoms pressure, discomfort, tightness, funny feeling, etc. John visits his doctor complaining of pain in his chest. Evaluation of chest pain differential diagnosis of symptoms. Differential diagnosis of pain around the hip joint. Chest pain is a common reason parents seek medical attention for their children. Two important factors modify the differential diagnosis in patients who present with abdominal pain. Accuracy of chest pain diagnosis using the history and physical examination determining whether pain is substernal. Colicky abdominal pain no bowel motions or flatus distended, tender abdomen tinkling bowel sounds. Cause grouping differentials classical history classic examination findings investigation findings.
Angina can be a sign of chd, even if initial tests dont point to the disease. Differential diagnosis of chest pain is generated almost entirely by history, with some addition of exg, chest xray, and specific laboratory exams. Although the differential diagnosis of chest pain is exhaustive, chest pain in. Chest pain differential diagnosis linkedin slideshare. According to diagnosispro, there can be more than 440 differential diagnosis of chest pain which includes both serious and well. Centers for disease control and prevention, national center for health statistics.
Oxford university press makes no representation, express or implied, that the drug dosages in this book are correct. 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. Differential diagnosis of angina differential diagnosis. Evaluation of chest pain differential diagnosis of symptoms bmj.
Chapter 53 approach to the patient with chest pain. The clinician must elicit a relevant and accurate history of the current event as well as symptoms that have recently been experienced by the patient. Therefore, the differential diagnosis of abdominal pain can be organized based on whether patients are presenting with their first episode of acute abdominal pain, a recurrent episode of acute abdominal pain, or chronicsubacute abdominal pain. Jun 23, 2014 rapid access chest pain clinics have improved diagnosis of incident angina in those with high risk of cardiovascular disease, but misdiagnosis rates are high and a recent study showed that a third of all cardiac events in subsequent followup occurred in those diagnosed with noncardiac chest pain. 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. The evaluation and management of the patient with chest pain syndrome is a diagnostic challenge to all who practice emergency medicine. It usually occurs due to visceral and parietal pleura rubbing over each other but can be due to musculoskeletal or nerverelated pathology. It is important that patients presenting with chest pain are rapidly and skilfully assessed so that the correct working diagnosis can be made and appropriate treatment offered. The differential diagnosis of chest pain presents a clinical challenge because chest pain related to myocardial infarction can be immediately life threatening. 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. Differential diagnosis of chest discomfort and general approach to. Management and differential diagnosis of patients with chest pain chest discomfort. Differential diagnosis for pleuritic chest pain oxford.
Approach to chest pain differential diagnosis of chest. 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 mnemonic easytoremember ddx. Differential diagnosis of acute chest pain oscestop. Benign, painful, localized swelling of costosternal, sternoclavciular, or costochondral joints. 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.
Angina pectoris, chest pain, differential diagnosis, electrocardiography, medical history taking, physical examination, practice guidelines, symptoms. Oza, md, mph, the ohio state university, columbus, ohio. Differential dx strategies university of massachusetts. You will not miss any highrisk causes if you remember this.
Chest pain the guideline is intended for health care professionals, including family physicians, nurses, pediatricians, and others involved in the organization and delivery of health services to provide practical and evidencebased information about management and differential diagnosis of chest pain in adult and pediatric patients. However, further observation9 raised some doubt about the diagnosis. Learn history taking, physical examination, ecg changes and lab tests. In the uk, 1% to 2% of adults attend primary care each year with a new presentation of chest pain. Chest pain knowledge for medical students and physicians. Differential diagnosis for chest pain oxford medical education. This refers to chest pain that is not sharp and is not the patients familiar angina.
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. Assessment of chest pain differentials bmj best practice. Table 1 lists the differential diagnosis of chest pain. Cpg chest pain en pdf american international health. The differential diagnosis of chest pain sciencedirect. Differential diagnosis for the advanced practice nurse. Nov 15, 2005 chest pain is the chief complaint in about 1 to 2 percent of outpatient visits,1 and although the cause is often noncardiac, heart disease remains the leading cause of death in the united states. Consequently, patients presenting with a complaint of chest pain frequently require serial evaluations, and admission to an observation unit or the hospital. Differential diagnosis of abdominal pain anatomic approach anatomic structure diagnosis. Pdf differential diagnosis of pain around the hip joint. Evaluation of abdominal pain in the emergency department. 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, diagnosis can be difficult because the pain usually appears before the characteristic rash. Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the us per year. Evaluation of chest pain differential diagnosis of. Abc of emergency differential diagnosis pdf free download. 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 different condition which may cause chest pain differential diagnosis of chest pain angina angina pain may last from 2 10 minutes, the character of pain is heaviness, or tightness, sensation around the chest, it is located in the centre of chest. May 11, 2018 here are some simplified examples of what a differential diagnosis may look like for some common conditions. Conventional radiography, barium swallow, and, especially, contrastenhanced ct are of great value for the timely detection of boerhaaves syndrome. It is the presenting complaint in 1% of officebased visits. According to diagnosispro, there can be more than 440 differential diagnosis of chest pain which includes both serious and well as non serious diseases and health problems. Chest pain is actually one of the most nuanced symptoms in clinical practice and it is fundamental to be able to differentiate benign from serious etiologies. Outpatient diagnosis of acute chest pain in adults john r.
Differential diagnosis for chest pain oxford medical. Chest pain radiating to the left arm mi chest pain worse with movement musculoskeletal pain benefits. Pleuritic chest pain refers to pain felt worse on inspiration. Pdf on mar 1, 2018, thiago almeida ribeiro and others published boerhaaves syndrome. 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. Nurses will play an increasing role in the differential diagnosis of chest pain and. Its fast, the common things usually come to mind, and it is how most clinicians think. First of all, today, in this article we are sharing the abc of emergency differential diagnosis pdf file with our valuable audience. Table 31 outlines the typical time course associated with different diseases causing abdominal pain.
The clinician must elicit a relevant and accurate history of the current event as well as symptoms. Dec 10, 2002 it is important that patients presenting with chest pain are rapidly and skilfully assessed so that the correct working diagnosis can be made and appropriate treatment offered. Additionally, patients who complain of chest pain wont always have the expected signs and symptoms. Chestpain general presentation in children and adolescents, chest pain is a commonly encountered problem. Also, this book is considered to be among the best selling when it comes to the emergency differential diagnosis. Outpatient diagnosis of acute chest pain in adults american. Chest pain is pain or discomfort in the chest, typically the front of the chest. Differential diagnosis of chest pain our patients chief complaint was severe chest pain, which by history, location, and type of chest pain seemed to be typical for angina pectoris. Evaluation of chest pain in 2019 american college of physicians. 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. Chest pain differential diagnosis free questions and answers for doctors and medical student exams. 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. Male female perforated ulcer nonspecific gastritis diverticulitis appendicitis acute cholecystitis the other factor is age over 70 years.
This new title in the abc series covers the assessment, diagnosis, treatment, and management of the most common symptoms with. Approach to undifferentiated chest pain in the emergency. Chest pain is one of the most common symptoms in the emergency department, as well as in primary health care. Oshea and others published differential diagnosis of chest pain find, read and cite all the research you need on. Myocardial ischemia or infarction, 1076 pericardial disease, 1076. Strategies for generating differential diagnoses a number of different strategies can be used to generate a differential diagnosis. Aug 04, 2018 first of all, today, in this article we are sharing the abc of emergency differential diagnosis pdf file with our valuable audience. Pdf low back pain is a symptom affecting millions of adults annually. Alright, so when youre presented with chest symptoms as mentioned above, you have to immediately ask, who is your pappa. Here are some simplified examples of what a differential diagnosis may look like for some common conditions. 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.
Sections of the guide line were developed for use by patients and their. After generating a differential, you may decide that you would like to expand upon it. Certain strategies work better for different symptoms. Chest pain is the chief complaint in about 1 to 2 percent of outpatient visits,1 and although the cause is often noncardiac, heart disease remains the leading cause of death in the united states.
The quote listen to your patient, he is telling you the diagnosis is attributed to the canadian physician william osler. 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%. Chest pain syndrome is inclusive of symptoms that may be caused by acute myocardial ischemia and includes such diverse complaints as chest pain, chest pressure. Differential diagnosis of chest pain request pdf researchgate. Chest radiography can be useful in differential diagnosis and should be obtained on all patients. Inflammation of costal cartilages or sternal articulations.
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