chest pain seminar prepared by | abdullah a. laftal group 32 | medicine 3
TRANSCRIPT
Chest pain Seminar
Prepared by | Abdullah A. Laftal Group 32 | Medicine 3
Objectives :
define chest pain . state the causes , prevalence management of patient with chest pain
Chest pain :
symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain
Case 1 :
A 53-year-old man was admitted to the hospital .The patient had been well until three months earlier, when he began to have increasingly severe exertional dyspnea, without chest pain.
On the day of admission, he had been at work, lifting and transporting heavy objects, when a sensation of "heaviness"
developed across his chest, accompanied by dyspnea.
In an ambulance en route to this hospital, ventricular fibrillation was discovered, and a single shock resulted in reversion to a normal rhythm.
An electrocardiogram obtained at the time of his arrival at
this hospital showed elevated ST segments in leads V1
through V4, with depressed ST segments in leads II and III
The patient had a 40-pack-year history of cigarette smoking;
he drank little alcohol. He had hypertension and
hyperlipidemia and took medications for both. There was no history of diabetes mellitus or previous chest pain and no family history of coronary disease.
On physical examination :
Temperature was 38.3°C pulse was 85blood pressure was 115/80 mm Hg. The patient was alert and comfortable. The jugular venous pressure was 8 cm of water. Bibasal crackles were present. A grade 1 systolic murmur was heard, with a third heart sound. The abdomen was normaland there was no peripheral edema.
Management :
Oxygen, lidocaine, aspirin, and metoprolol were administered,
the patient was transported urgently to the cardiac catheterization unit.
A coronary angiographic study revealed three-vessel disease,
including complete occlusion of the left anterior descending
artery at its ostium. A stent was placed
DDx :
Pulmonarypneumonia pulmonary embolism (PE)* pneumothorax/hemothorax* empyema pulmonary neoplasm bronchiectasis TB
Cardiac MI angina* myocarditis
Pericarditis cardiac tamponade*
Gastrointestinal Esophageal spasm, GERD, esophagitis, ulceration, achalasia, neoplasm PUD gastritis pancreatitis biliary colic
mediastinallymphoma Thymoma
vascular aortic aneurysm
surface structures costochondritis
rib fracture skin (bruising, shingles)
breast
Chest pain :
DisorderMediastinal
displacementChest wall movement
Percussion noteBreath soundsAdded sounds
ConsolidationNoneReduced over affected area
DullBronchialCrackles
TBNone None NoneNone None
Pleural effusionHeart displaced to opposite side
(trachea displaced only
if massive)
Reduced over affected area
Stony dullAbsent over fluid; may be bronchial at
upper border
Absent; pleural rub may be
found above effusion
PneumothoraxTracheal deviation to
opposite side if under tension
Decreased over affected area
ResonantAbsent or greatly reduced
Absent
PENone None None None Pleural friction rub
An infiltrate in the medial segment of the right middle lobe will obscure the right heart border on the frontal view ,
on the lateral view, is seen as a triangular density radiating from the hilum toward the anterior and lower part of the chest
Group 32 medical student send the gratitude and thanks to Dr.Abdullah Assiri
Dr.Mohammad Younis Khanfor their support .
Also to the organizing committee of SHA 21 scientific session for encourage young researchers