Transcript previous chest pain

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 85
blood 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 normal
and 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 :
Pulmonary
pneumonia
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
mediastinal
lymphoma
Thymoma
vascular
aortic aneurysm
surface structures
costochondritis
rib fracture
skin (bruising, shingles)
breast
Chest pain :
Disorder
Consolidation
Mediastinal
displacement
None
TB
None
Chest wall
movement
Reduced over
affected area
None
Pleural effusion Heart displaced Reduced over
to opposite side affected area
(trachea
displaced only
if massive)
Pneumothorax
Tracheal
Decreased over
deviation to
affected area
opposite side if
under tension
PE
None
None
Percussion
note
Dull
None
Stony dull
Breath sounds Added sounds
Bronchial
Crackles
None
None
Absent over Absent; pleural
fluid; may be
rub may be
bronchial at
found above
upper border
effusion
Resonant
Absent or
greatly reduced
Absent
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 Khan
for their support .
Also to the organizing committee of SHA 21 scientific session for
encourage young researchers