chest pain history
DESCRIPTION
clinical approach to a patient with chest painTRANSCRIPT
CHEST PAIN
HISTORY ????..
•SITE•ONSET•CHARACTER•SEVERITY•DURATION•RADIATION•AGGRAVATING FACTORS•RELIEVING FACTORS•ASSOCIATED SYMPTOMS
SITE
RETROSTERNAL PERIPHERAL
RETROSTERNAL•CARDIAC-ANGINA, MI,MYOCARDITIS,PERICARDITIS, MVP
•MEDIASTINAL-TRACHEITIS,MALIGNANCY
•AORTIC-DISSECTION,ANEURYSM
•ESOPHAGEAL-ESOPHAGITIS,SPASM,MALLORY WEISS SYNDROME
•ANXIETY/EMOTION
PERIPHERALLUNG/PLEURAL-PNEUMOTHORAX,INFARCT.
MALIGNANCY
MUSCULOSKELETAL-RIB#,MUSCLE INJURY,OSTEOARTHRITIS,OSTEOCHONDRITIS
BREAST DISORDERS
NEURALGIC-IVDP,HERPES
ANXIETY
ONSETSUDDEN RETROSTERNAL-
MI,PNEUMOTHORAX,PULM. EMBOLISM,ESOPHAG. RUPTURE
PERIPHERAL-PNEUMOTHORAX,PE
GRADUALLY ON EXERTION-ANGINA
AFTER VOMITING-ESOPHAGEAL RUPTURE
CONSTANT-PERICARDITIS,MUSCULOSKELETAL ,GI
OCCURING WHEN ?DURATION?
ON EXERTION-CARDIAC PAIN
ON FOOD INTAKE-ESOPHAGEAL
ANGINA <20min
MI >30min
CHARACTER & SEVERITYCONSTRICTING-
CARDIAC,ESOPHAGEAL SPASM
STABBING-PLEURAL,MUSC. SK
LEVINE’S SIGN
AGGRAVATING FACTORSANGINA-
EXERTION,EMOTION,COLD,HEAVY MEAL
PERICARDITIC/PLEURITICSWALLOWING,MOVEMENT,COU
GH’G,RESPIRATIONMUSCULOSKELETALAGGRAVATED WITH MOVEMENT
RELIEVING FACTORSANGINA-REST
ESOPHAGITIS-FOOD,ANTACID,MILK
PLEURITIC-HOLDING BREATH
ASSOCIATED SYMPTOMS
BREATHLESSNESS-MI,PNEUMOTHORAX,PE
FEVER-PERICARDITIS,PLEURITIS
DYSPHAGIA-ESOPHAGEAL D/S
PARAESTHESIA,HEADACHE,INSOMN. -ANXIETYPAIN &HEMATEMESIS-
MWS,ESOPH.RUPTURE
CARDIAC PAIN
CENTRAL, DIFFUSECONSTICTINGRADIATION EXERTION,EMOTION
REST, NITRATESBREATHLESSNESS,AUT
DISTURBANCES
NON CARDIAC PAIN
PERIPH,LOCALIZEDSTABBINGPRESENT/ ABSENTPOSTURE, MVMTNOT RELIEVEDSYSTEM RELATED
PAST HISTORYDIABETES MELLITUSVASCULITISHYPERTENSIONSTEROIDS,OCPSPROLONGED BED REST/SURGERYTRAUMA/ASSAULT
PERSONAL HISTORYDIET
SMOKING
ALCOHOLISM
FAMILY HISTORYCADHYPERTENSIONDIABETES MELLITUSDYSLIPIDAEMIACOLLAGEN VASCULAR D/SCONGENITAL HEART D/S
TREATMENT HISTORYNSAIDS,ASPIRIN
STEROIDS
OCPs
CHEST PAIN
CARDIAC NON CARDIAC
ISCHAEMIC NON-ISCHAEMIC
ANGINA MI MYOCARDITIS PERICARDITIS MVP
THANK YOU….