Chest pain: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Tags: Manual revert Visual edit
 
(158 intermediate revisions by 20 users not shown)
Line 1: Line 1:
__NOTOC__
{| class="infobox" style="float:right;"
|-
| [[File:Siren.gif|30px|link=Chest pain resident survival guide]]|| <br> || <br>
| [[Chest pain resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
{{Chest pain}}
{{Chest pain}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org]
'''For resident survival guide, click [[Chest pain resident survival guide|here]]'''
 
'''For patient information, click [[Chest pain (patient information)|here]]'''
 
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{Sara.Zand}} {{Aisha}} {{IQ}} {{CZ}}; [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com] {{AMK}}, {{nuha}}
 
{{SK}}
==[[Chest pain overview|Overview]]==
 
==[[Chest pain historical perspective|Historical Perspective]]==


==Overview==
==[[Chest pain classification|Classification]]==
[[Chest Discomfort]] or chest pain is one of the commonest symptoms presented in the emergency department. It can be a manifestation of a benign condition like [[gastroesophageal reflux]] diseases to life threatening conditions like [[myocardial infarction]], [[aortic dissection]], [[tension pneumothorax]], or [[ pulmonary embolism]]. Thus, it requires careful consideration on the physician's part not to miss important diagnosis and also not to over-treat a simple condition. Several life threatening disorders should be excluded upon presentation. The frequency of non-acute myocardial infarction conditions in a decreasing order is: gastroesophageal disease commonest followed by [[ischemic heart disease]], and [[chest wall syndromes]] <ref name="pmid8809520">{{cite journal |author=Fruergaard P, Launbjerg J, Hesse B, Jørgensen F, Petri A, Eiken P, Aggestrup S, Elsborg L, Mellemgaard K |title=The diagnoses of patients admitted with acute chest pain but without myocardial infarction |journal=[[European Heart Journal]] |volume=17 |issue=7 |pages=1028–34 |year=1996 |month=July |pmid=8809520 |doi= |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=8809520 |accessdate=2012-05-02}}</ref>. Other less frequent diagnoses included [[pulmonary embolism]], [[pleuritis]]/[[pneumonia]], [[lung cancer]], [[aortic stenosis]], [[aortic aneurysm]] and [[herpes zoster]]. The first diagnostic study to be ordered within 10 minutes is the [[electrocardiogram|12 lead electrocardiogram]]. A full medical history may assist in the prompt management of the patient with chest pain. The relief of chest pain by administration of sublingual [[nitroglycerin]] in outpatient setting is not diagnostic of [[coronary artery disease]]. For instance, esophageal pain can be relieved by administration of [[nitroglycerin]]. Likewise, the relief of chest pain by the administration of liquid or chewable [[antacids]] and anti reflux drugs does not exclude [[coronary artery disease]] as the underlying etiology of the pain.


==History and Symptoms==
==[[Chest pain pathophysiology|Pathophysiology]]==
Thorough history including: Onset, duration, type of pain, location, exacerbating factors, alleviating factors, radiation. Risk factors for coronary artery disease: [[family history]], [[smoking]], [[hyperlipidemia]], and [[diabetes]]
===Clinical features of different conditions presenting with acute chest discomfort===
{| border="1" cellpadding="5" cellspacing="0" align="center" class="sortable" style="text-align:center;"
|-
  ! Condition
  ! Onset
  ! Duration
  ! Type of pain
  ! Location
  ! Exacerbating factors
  ! Alleviating factors
  ! Radiation
  ! Associated symptoms
|-
  |'''Cardiovascular'''
|-
  |'''[[Stable Angina]]'''
  |Sudden (acute)
  |2-10 minutes
  |Heaviness, pressure, tightness, squeezing, burning ([[Levine's sign]])
  |Retrosternal
  |Exertion, emotions, cold
  |Rest, sublingual nitroglycerine (within minutes)
  |Radiation to neck, jaw, shoulders, or arms (commonly on left)
  |[[Diaphoresis|Sweating]], [[nausea]], [[palpitations]], [[dizziness]], [[shortness of breath]], sense of impending doom
|-
  |'''[[Unstable Angina]]'''
  |Acute
  |10-20 minutes
  |same as stable angina but often more severe
  |same as stable angina
  |same as stable angina but occurs with lower levels of exertion & rest
  |same as stable angina
  |same as stable angina
  |same as stable angina
|-
  |'''[[Myocardial Infarction]]'''
  |Acute
  |commonly > 20 minutes
  |same as stable angina but often more severe
  |same as stable angina
  |same as stable angina but occurs with lower levels of exertion & rest
  |Usually unrelieved by nitroglycerine and rest
  |same as stable angina
  |same as stable angina
|-
  |'''[[Aortic stenosis]]'''
  |Acute, '''recurrent episodes of angina'''
  |same as stable angina
  |same as stable angina
  |same as stable angina
  |same as stable angina
  |same as stable angina
  |same as stable angina
  |Late systolic murmurs (radiating to carotid arteries)
|-
  |'''[[Aortic dissection]]'''
  |Acute
  |Variable
  |Tearing sensation, knife like
  |Anterior chest
  |Variable
  |unrelenting pain, unrelieved by nitroglycerine and rest
  |Radiating to back, between shoulder blades
  |[[Hypertension]], connective tissue disease ([[marfan's syndrome]]), murmur ([[aortic regurgitation]], [[pericardial rub]]), impalpable peripheral pulses
|-
  |'''[[Pericarditis]]'''
  |Acute or subacute
  |May last for hours to days
  |Sharp, localized
  |Retrosternal
  |Variable
  |Relieved by sitting up and leaning forward
  |Radiation to left shoulder
  |[[Pericardial friction rub]]
|-
|'''Pulmonary'''
|-
  |'''[[Pulmonary embolism]]'''
  |Acute
  |May last minutes to hours
  |Sharp, or knifelike pleuritic pain
  |Localized to side of lesion
  |Increased on respiratory movements as deep breathing or [[cough]]
  |Not specific
  |Not specific
  |[[Dyspnea]], [[tachypnea]], [[tachycardia]], and [[hypotension]]
|-
  |'''[[Pneumothorax|Spontaneous Pneumothorax]]'''
  |Acute
  |May last minutes to hours
  |Sharp, localized pleuritic
  |Localized to side of lesion
  |Not specific
  |Not specific
  |Not specific
  |Dyspnea, decreased breath sounds on involved side
|-
  |'''[[Pleuritis]]'''
  |Acute, subacute, chronic
  |May last minutes to hours
  |Sharp, localized pleuritic
  |Localized to side of lesion
  |Not specific
  |Not specific
  |Not specific
  |Dyspnea, cough, fever, rales, pleuritic rub (when associated with [[pneumonia]])
|-
  |'''[[Pulmonary hypertension]]'''
  |Acute, subacute, chronic
  |Variable
  |Pressure like
  |Substernal
  |Not specific
  |Not specific
  |Not specific
  |Dyspnea, signs of [[right heart failure]] ([[edema]] & [[elevated jvp]]
|-
|'''Gastrointestinal'''
|-
  |'''[[GERD]], [[Peptic ulcer]]'''
  |Acute
  |Minutes to hours (gastroesophageal reflux), prolonged (peptic ulcer)
  |Burning
  |Substernal, epigastric
  |Increases on post meal lying down
  |Relieves on antacid, food
  |Not specific
  |Not specific
|-
  |'''[[Esophageal spasm]]'''
  |Acute
  |Minutes to hours
  |Burning, pressure
  |Retrosternal
  |Not specific
  |Not specific
  |Not specific
  |Not specific (closely mimic angina)
|-
  |'''[[Gallstone disease| Cholelithasis]]'''
  |Acute, subacute
  |Minutes to hours
  |Burning, colicky
  |Right upper abdomen, substernal, epigastric
  |Increases post meal, fatty food
  |Analgesics
  |Not specific
  |Not specific
|-
|'''Miscellaneous'''
|-
  |'''[[Muscular pain|Musculo-skeletal pain]]'''
  |Acute, subacute
  |Variable
  |Pressure, aching
  |Localized to involved area
  |Increases by movement and pressure on involved area
  |Analgesics
  |Not specific
  |Not specific
|-
  |[[Psychotic conditions]]
  |Acute, subacute, chronic
  |Variable
  |Variable
  |Variable
  |Variable
  |Not specific
  |Not specific
  |Not specific
|-
|}


==Physical Examination==
==[[Chest pain causes|Causes]]==
===Vitals===
* Temperature (pericarditis, pleuritis, fever can precipitate ischemic attacks)
* Pulses in all four limbs (aortic dissection)
* Blood pressure in both the arms (aortic dissection)
===General physical examination===
* Elevated [[jugular venous pulse]]
===Cardiovascular===
* Auscultation
** Third and fourth heart sound
** [[Carotid bruit]]
** Pericardial rub ([[pericarditis]])
** Murmur (systoloic murmur in [[Hypertrohic cardiomyopathy]], [[aortic stenosis]])
===Other organ system===
====Pulmonary====
* Palpation - shift in trachea from midline (tension pneumothorax)
* Auscultation - Decreased breath sound (pulmonary edema), pleural rub (pleuritis, pneumonia)
====Genitourinary system====
* Rectal examination - occult bleeding


==Laboratory Findings==
==[[Chest pain differential diagnosis|Differentiating Chest pain from other Diseases]]==
On the basis of the above, a number of tests may be ordered:
*'''[[Electrocardiogram]] ([[ECG]]):''' usually required for initial evaluation. [[ST elevation]] should require further urgent evaluation for reperfusion therapy.


*[[Blood test]]s:
==[[Chest pain epidemiology and demographics|Epidemiology and Demographics]]==
:::* [[Complete blood count]]
:::* [[Electrolyte]]s and [[renal function]] ([[creatinine]])
:::* [[Liver function tests|Liver enzyme]]s
:::* [[Creatine kinase]] (and ''CK-MB'' fraction in many hospitals)
:::* [[Troponin]] I or T (to indicate [[myocardium|myocardial]] damage)
:::* [[D-dimer]] (when suspicion for [[pulmonary embolism]] is present but low)


*[[X-ray]]s of the chest and/or abdomen:
==[[Chest pain risk factors|Risk Factors]]==
::*A [[chest X-ray]] can be useful in the initial evaluation of the patient to ascertain if there is [[cardiomegaly]], [[pulmonary edema]] and [[aortic dissection]].
::*[[Computed tomography|CT scanning]] may be better but is often not available


*'''Echocardiography or Ultrasound:'''
==[[Chest pain screening|Screening]]==
::* [[Echocardiogram]] usually required for patients with suspected [[coronary artery disease]]
::* To rule out [[aortic dissection]], [[transesophageal echocardiogram]] of the chest may be indicated


*'''MRI and CT:'''
==[[Chest pain natural history, complications and prognosis|Natural History, Complications, and Prognosis]]==
::* [[CT]] scan of abdomen and chest may be helpful in ruling out [[pulmonary embolism]]
::* To rule out [[aortic dissection]], a [[CT]] scan or [[MRI]] of the chest may be indicated


*'''Other Imaging Findings:'''
==Diagnosis==
::*[[Ventilation/perfusion scan|V/Q scintigraphy]] or CT Pulmonary angiogram (when a [[pulmonary embolism]] is suspected)
[[Chest pain diagnostic study of choice|Diagnostic study of choice]] | [[Chest pain history and symptoms|History and Symptoms]] | [[Chest pain physical examination|Physical Examination]] | [[Chest pain laboratory findings|Laboratory Findings]] | [[Chest pain electrocardiogram|Electrocardiogram]] | [[Chest pain x ray|X-Ray Findings]] | [[Chest pain echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Chest pain CT scan|CT-Scan Findings]] | [[Chest pain MRI|MRI Findings]] | [[Chest pain other imaging findings|Other Imaging Findings]] | [[Chest pain other diagnostic studies|Other Diagnostic Studies]]
::*For patients who are suspected to have [[coronary artery disease]] may require stress testing or [[cardiac catheterization]]
::*Peak flow studies and pulmonary function tests may be indicated for patients requiring further evaluation
*'''Other Diagnostic Studies:'''
::* Upper gastrointestinal [[endoscopy]] if [[esophagitis]] is suspected
==Interpretation==
*In finding the cause, '''the history given by the patient is often the most important tool'''. In [[angina pectoris]], for example, blood tests and other analyses are not sensitive enough ''(Chun & McGee 2004)''.
*The physician's typical approach is to '''rule-out the most dangerous causes of chest pain first''' (e.g., heart attack, blood clot in the lung, aneurysm).  By sequential elimination or confirmation from the most serious to the least serious causes, a diagnosis of the origin of the pain is eventually made.
*Often, no definite cause will be found, and the focus in these cases is on '''excluding severe diseases and reassuring the patient'''.
*If [[acute coronary syndrome]] (e.g.[[unstable angina]]) is suspected, many patients are admitted briefly for observation, sequential [[ECG]]s, and determination of cardiac enzyme levels over time ([[creatine kinase|CK-MB]], [[troponin]] or [[myoglobin]]). On occasion, later out-patient testing may be necessary to follow-up and make better determinations on causes and therapies.
==5 Life Threatening Diseases to Exclude Immediately==
* [[Aortic Dissection]]
* [[Esophageal Rupture]]
* [[Myocardial Infarction]]
* [[Pulmonary Embolism]]
* [[Tension Pneumothorax]]


==Differential Diagnosis of Chest Pain==
{|style="width:100%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | • [[Aortic Dissection|Acute Aortic Dissection]] • [[Acute Coronary Syndrome]] • ([[unstable angina]]) • ([[non ST elevation MI]]) • ([[ST elevation MI]]) • [[Aortic Aneurysm]] • [[Aortic Stenosis]] • [[Arryhthmias]] • [[Bland-White-Garland Syndrome]] • [[Chronic Stable Angina]] • [[Cor pulmonale]] • [[Coronary Heart Disease]] • [[Dressler's syndrome | Dressler's syndrome (postpericardiotomy)]] • [[Cardiomyopathy|Hypertrophic Cardiomyopathy]] •[[Mitral valve prolapse]] • [[STEMI|Myocardial infarction]] • [[Myocarditis]] • [[tamponade|Pericardial tamponade]] •[[Pericarditis]] • [[Takotsubos cardiomyopathy]] • [[Stress cardiomyopathy]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| Carbon monoxide poisoning • Lead poisoning
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Herpes zoster]] •
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| Drugs to treat [[migraine headache]] •
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| • [[Retropharyngeal abscess]] •
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| • [[Acromegaly]] •  [[Hyperthyroidism]] •  [[Hypothyroidism]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes •
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| • [[Achalasia]] • [[Abdominal distension]] • [[Barret’s esophagus]] • [[Carcinoma]] • [[Cholecystitis]] •[[Cholelithiasis]] • [[Diverticulitis]] • [[Duodenitis]] • [[Esophageal rupture]] • [[Esophageal spasm]] • [[Esophagitis]] •[[Foreign body]] • [[Gastritis]] • [[Gastroesophageal reflux]] ([[GERD]]) • [[Hiatus Hernia]] • [[Impacted stone]] • [[Liver abscess]] • [[Mallory-Weiss Syndrome]] • [[Neoplasm]] • [[nutcracker's esophagus|Nutcracker's esophagus]] • [[Pancreatitis]] •[[Peptic ulcer disease]] • [[Perforated ulcer]] • [[Plummer-Vinson Syndrome]] • [[Pneumoperitoneum]] • [[Splenomegaly|Splenic enlargement]] • [[Splenic infarction]] • Subdiaphragmatic abcsess • [[Subphrenic abscess]] • [[Whipple's Disease]] • 
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes •
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Sickle cell anemia]] •
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes •
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| • [[Bornholm disease]] • [[Hepatitis]] • [[HIV|HIV infection]] • [[Herpes Zoster]] • 
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| • [[Bechterew's Disease]] • [[Bone tumor]] • Chest wall pain syndrome • [[Costochondritis]] • Chosto condral tendinitis • Chosto sternal tendinitis • [[Tietze's syndrome]] • CS/TS osteochondrosis • [[Fibromyalgia]] • [[Fractured rib]] •[[Intercostal muscle spasm]] • Interstitial fibrosis • [[Intercostal neuralgia]] • [[Muscle strain or spasm]] • Myofascial pain •[[Myostitis]] • [[Neuritis]] • [[Radiculitis]] • [[Periostitis]] • [[Precordial catch syndrome]] • [[bursitis|Shoulder bursitis]] •[[tendinitis|Shoulder tendinitis]] • [[tumor|Soft tissue sarcoma or tumor]] • Sternoclavicular arthritis • Strain of pectoralis muscle • [[Thoracic Outlet Syndrome]] • [[Trauma]] • Vertebrogenic thoracic pain
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| • [[Tabes dorsalis]] •
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes •
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| • [[Liver cancer]] • [[Mesothelioma]] • [[Metastatic tumor]] • [[Neurofibroma]] • [[Pheochromocytoma]] •
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes •
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes •
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| • [[Anxiety|Anxiety disorders]] • [[Affective disorders]] (e.g., [[depression]]) • [[Da costa's syndrome]] • Thought disorders (e.g., [[delusions|fixed delusions]]) • [[Hyperventilation syndrome]] • [[Hypochondria]] • [[Factitious disorders]] (e.g. [[Münchausen syndrome]] • [[Fabricated or induced illness]] • Hospital addiction syndrome • [[Panic attack]] •[[Somatoform disorder]]s •  [[Somatization disorder]] •
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| • [[Asthma]] • [[Bronchial carcinoma]] • [[Bronchiectasis]] • [[Bronchogenic carcinoma]] • [[Carcinomatous]] •[[Pleural Effusion]] • [[Chronic Obstructive Pulmonary Disease]] ([[COPD]]) • [[Empyema]] • [[Hemothorax]] • [[Lung Abscess]] •[[Lung Cancer]] • [[Lymphoma]] • [[Mediastinitis]] • [[Pleuritis]] • [[Pleurodynia]] • [[Pneumomediastinum]] • [[Pneumonia]] •[[Pneumothorax]] • [[Pulmonary Embolism]] • [[Pulmonary Infarction]] • [[pneumothorax|Tension pneumothorax]] • [[Thymoma]] • Tracheoesophageal abscess • [[Tuberculosis]] • 
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes •
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Familial mediterranean fever]] • 
|-
|-bgcolor="LightSteelBlue"
| '''Substance abuse'''
|bgcolor="Beige"| [[Cocaine]] •
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| Chest wall injuries • 
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| • Collagen vascular disease with pleuritis • [[Conn's Syndrome]] • Degenerative changes of cervical spine •[[Peritonitis]] • [[Pott's Disease]] • [[Xiphodynia]] •
|-
|}
==Treatment==
==Treatment==
'''Immediate Management:'''
[[Chest pain medical therapy|Medical Therapy]] | [[Chest pain interventions|Interventions]] | [[Chest pain surgery|Surgery]] | [[Chest pain primary prevention|Primary Prevention]] | [[Chest pain secondary prevention|Secondary Prevention]] | [[Chest pain cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Chest pain future or investigational therapies|Future or Investigational Therapies]]
* Special attention to: '''airway''', '''breathing''', and '''circulation'''
 
* Treat all underlying etiologies as clinically indicated
==Case Studies==
* Supplemental O2 should be administered to patients with suspected [[coronary artery disease]]
[[Chest pain case study one|Case #1]]


'''Acute Pharmacotherapies:'''
==Related Chapters==
* For patients with [[coronary artery disease]]:
*[[NICE guidelines for management of chest pain]]
*:* [[Aspirin]]
*[[Unstable angina]]
*:* [[Nitroglycerin]]
*[[Chronic stable angina]]
*:* [[Morphine]] (if necessary)
*[[Myocardial infarction]]
* For patients with [[myocardial infarction]]:
*[[Pulmonary embolism]]
*:* [[Heparin]]
*[[Pneumonia]]
*:* [[Beta-blockers]]
*[[Costochondritis]]
*:* [[ACE inhibitors]]
*[[Cardiogenic shock]]
*:* [[Thrombolytic therapy]]
*[[The Patient History in Cardiovascular Disease]]
*:* [[Glycoprotein IIb/IIIa inhibitors]]
*[[Diagnosis Wikidoc: Chest Pain no ST elevation]]
*[[Diagnosis WikiDoc:Chest Pain]]
*[[Pleuritic chest pain]]
*[[GERD]]
*[[Dysphagia]]


'''Surgery and Device Based Therapy:'''
* For patients in which [[myocardial infarction]] is suspected, [[angioplasty]] may be indicated
* For patients with [[aortic dissection]]s, emergent surgery may be required.<ref name="pmid15336583">{{cite journal |author=Chun AA, McGee SR |title=Bedside diagnosis of coronary artery disease: a systematic review |journal=Am. J. Med. |volume=117 |issue=5|pages=334–43 |year=2004 |month=September |pmid=15336583 |doi=10.1016/j.amjmed.2004.03.021 |url=}}</ref><ref name="pmid16568192">{{cite journal |author=Ringstrom E, Freedman J |title=Approach to undifferentiated chest pain in the emergency department: a review of recent medical literature and published practice guidelines |journal=Mt. Sinai J. Med. |volume=73 |issue=2|pages=499–505 |year=2006 |month=March |pmid=16568192 |doi= |url=http://www.mssm.edu/msjournal/73/732499.shtml}}</ref><ref name="pmid16500201">{{cite journal |author=Butler KH, Swencki SA |title=Chest pain: a clinical assessment |journal=Radiol. Clin. North Am. |volume=44 |issue=2 |pages=165–79, vii |year=2006 |month=March |pmid=16500201 |doi=10.1016/j.rcl.2005.11.002|url=}}</ref><ref name="pmid16326253">{{cite journal |author=Haro LH, Decker WW, Boie ET, Wright RS |title=Initial approach to the patient who has chest pain |journal=Cardiol Clin |volume=24 |issue=1 |pages=1–17, v |year=2006 |month=February |pmid=16326253|doi=10.1016/j.ccl.2005.09.007 |url=}}</ref><ref name="pmid17080889">{{cite journal |author=Fox M, Forgacs I |title=Unexplained (non-cardiac) chest pain |journal=Clin Med |volume=6 |issue=5 |pages=445–9 |year=2006 |pmid=17080889 |doi=|url=http://openurl.ingenta.com/content/nlm?genre=article&issn=1470-2118&volume=6&issue=5&spage=445&aulast=Fox}}</ref>
==Sources==
*The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction <ref name="pmid15339869">{{cite journal |author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK |title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction) |journal=Circulation |volume=110 |issue=9|pages=e82–292 |year=2004 |month=August |pmid=15339869 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref>
*The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee|journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078|doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>
==References==
==References==
{{reflist|2}}
{{Reflist|2}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}


[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
 
[[Category:Up-To-Date]]
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Latest revision as of 20:38, 29 November 2022
Resident
Survival
Guide

Chest pain Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chest pain from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Chest Pain in Pregnancy

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Chest pain On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chest pain

CDC on Chest pain

Chest pain in the news

Blogs on Chest pain

to Hospitals Treating Chest pain

Risk calculators and risk factors for Chest pain

For resident survival guide, click here

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3] Iqra Qamar M.D.[4] Cafer Zorkun, M.D., Ph.D. [5]; Priyamvada Singh, M.B.B.S. [6] Amresh Kumar MD [7], Nuha Al-Howthi, MD[8]

Synonyms and keywords:

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chest pain from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic study of choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Interventions | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

References

Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Chest_pain&oldid=1731358"