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| {| class="wikitable"
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| |+ [[Chest pain]] associated different organs
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| ! colspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Charactristics of chest pain}}
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| |-
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| | rowspan="4" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Musculoscletal]] origin
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| *[[Chest]] wall tenderness
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| |-
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| *[[Pain]] aggravated with [[inspiration]]
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| |-
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| *[[Muscle pain]] with movement
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| |-
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| *[[Tenderness]] on [[palpation]] of [[costochondral junction]]
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| |-
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| | rowspan="2" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Respiratory]] origin
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| *[[Chest pain]] secondary to acute onset of [[cough]]
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| |-
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| *[[Wheezing]], [[coughing]], [[asthma]]
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| |-
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| | rowspan="2" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Gastrointestinal]] origin
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| *[[Chest pain]] associated with [[indigestion]], [[heart burn]], [[vomotting]]
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| |-
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| * Evidence in [[endoscopy]]: [[gastrointestinal reflex]],[[gastritis]],
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| |-
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| | rowspan="3" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Cardiac]] origin
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| *[[Congenital heart disease]]
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| |-
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| *[[Kawazaki]]
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| |-
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| *[[Arrhythmia]]
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| |-
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| | rowspan="2" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Psychogenic origin]]
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| *[[School problem]]
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| |-
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| *[[Family]] troubles such as [[parents divorce]]
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| |-
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| |rowspan="1" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Ideopathic]]
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| *No evidence of any organic etiology or any [[psychologic]] factors
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|
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| |}
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| {{familytree/start |summary=Sample 8}}{{familytree/start |summary=PE diagnosis Algorithm.}}
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| {{familytree/start}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF | | | | | | | | | | | | | A01 | | |A01=Sharp}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF | | | | | | | | | B01 |-|.|!|,|-| B02 | | | | | | | |B01=Dull|B02=Undefined}}
| |
| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF | | | | | C01 |-|-|-|-|-| C02 |-|-|-|-|-| C03 | | | |C01=Duration of chest pain|C02=Charactristics of chest pain|C03=Squeezing}}
| |
| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF | | | | | | | | | D01 |-|'|!|`|-| D02 | | | | | | | |D01=Chest wall tenderness|D02=Respiratory related}}
| |
| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF | | | | | | | | | | | | | B01 | | | | | | | | | |B01=<div style="float: left; text-align: left; height: 20em; width: 17em; padding:1em;"> '''Symptoms associated with [[Chest pain]] in [[children]]:'''<br>❑ [[Cough]] (23.4%) <br> ❑ [[Dyspnea]] (11%) <br> ❑ [[Abdominal pain]] (9.7%) <br> ❑ [[Palpitation]] (9.7%) <br> ❑ [[Respiratory related]] (9%) <br> ❑ [[Dizziness]] (5.8%)<br>❑ [[Post nasal drip]] (4.4%) <br>❑ [[Fever]] (5.2%) <br> ❑ [[Exercise induced]] (2.6%) <br>❑ [[Syncope]] (2.6%) <br></div>}}
| |
| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF | | | | | | | | | | | | | |!| | | | | | | | | | | | |}}
| |
| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF | | | | | | | | | | | | | F01 | | | | | | | | | | | |F01=<div style="float: left; text-align: left; height: 30em; width: 17em; padding:1em;"> '''Is there any red flag about [[cardiac]] etiology?:'''<br>
| |
| ----
| |
| ❑ History of acquired or [[congenital cardiac disease]] <br> ❑ Exertional [[syncope]] <br> ❑ Exertional [[chest pain]] <br> ❑ [[Hypercoagulable]] state <br> ❑ [[Hypercholesterolemic]] state ❑ [[Family history]] of [[sudden death]] under 35 years of age<br> ❑[[Family history]] of premature [[coronary artery disease]]<br>❑[[Inheritted arrhythmia]] in the first relative <br>❑[[ICD]] implantation <br>❑ [[Connective tissue disease]]<br>❑ Using [[cocaine]], [[amphetamine]]<br> </div>}}
| |
| {{familytree|boxstyle=background: #FA8072; color: #F8F8FF | | | | | | | | | | | | | |!| | | | | |}}
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| {{familytree|boxstyle=background: #FA8072; color: #F8F8FF | | | | | | | | | | | | | G01| | | | | G01=<div style="float: left; text-align: left; height: 30em; width: 17em; padding:1em;"> '''Laboratory investigation in suspicion of [[cardiac ]] etiology:'''<br>
| |
| ----
| |
| ❑ [[EKG]] <br> ❑ [[CXR]]<br> ❑ [[Echocardiography]] <br> ❑ [[Holter monitoring]] <br>
| |
| ❑ [[Exercise stress test]]<br> ❑ [[Dobutamin stress test]] <br> ❑ [[Thalium scan]] <br> ❑ [[Serum creatine kinase with MB fraction]] ❑ [[Serum troponin I]]<br> ❑[[Lipid ]]profile<br>❑[[Pericardiocenthesis]]<br>❑[[Endomyocardial biopsy]]<br>❑ [[Catheterization]]<br> </div>}}
| |
| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF | | | | |,|-|-|-|v|-|-|-|+|-|-|-|.| | | | | }}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF | | | | K01 | | K02 | | K03 | | K04 | | |K01=<div style="float: left; text-align: left; height: 30em; width: 17em; padding:1em;"> '''Laboratory investigation in suspicion of [[pulmonary ]] etiology:'''<br>
| |
| ----
| |
| ❑[[CXR]]<br>❑[[Chest CT scan]]<br>❑[[Magnetic resonance imaging]] of the [[chest]]<br>❑[[Pulmonary function test]] <br>❑[[Bronchoscopy]]<br>❑[[Ventilation perfusion scan]]<br>❑[[Sweat test]]<br></div>}}|
| |
| K02=<div style="float: left; text-align: left; height: 30em; width: 17em; padding:1em;"> '''Laboratory investigation in suspicion of [[gastrointestinal ]] etiology:'''<br>
| |
| ----
| |
| ❑ [[Gastric lavage]]<br> ❑[[PH]] probe<br>❑[[Upper GI series]]<br>❑[[Upper endoscopy]]<br>❑[[Abdominal sonography]]<br>❑[[Liver function test]]<br>❑[[Lipase]], [[amylase]]<br>❑[[Serum]] [[gastrin]] level<br>❑[[Stool]] [[guaic]] testing<br></div>}}|
| |
| K03=<div style="float: left; text-align: left; height: 30em; width: 17em; padding:1em;"> '''Laboratory investigation in suspicion of [[musculoskeletal ]] etiology:'''<br>
| |
| ----
| |
| ❑[[Skeletal radiography]]<br>❑[[Spine]] [[ CT scan]]<br>❑ Spine[[MRI]]<br>❑[[Nuclear bone scan]]<br>❑[[Creatine kinase]] with MM fraction<br></div>}}|
| |
| K04=<div style="float: left; text-align: left; height: 30em; width: 17em; padding:1em;"> '''Laboratory investigation for other etiology:'''<br>
| |
| ----
| |
| ❑ [[Viral]], [[bacterial]] antibody level<br>❑[[Psychologic testing]]<br>❑[[Culture]] of [[blood]], [[pericardial fluid]], [[sputum]]<br>❑[[Urine]], [[serum]] toxicology<br>❑[[Serum compelement level]]<br>❑Glycosylated [[Hb A1C]]<br>❑[[Hemoglobin electrophoresis]]<br>❑[[Cell blood count]]<br>❑[[Coagulation ]]study<br>❑[[ESR]]<br>❑[[Mamography]]<br>❑ [[Breast sonography]]<br>❑[[Breast biopsy]]<br>[[Thyroid function test]]<br></div>}}|
| |
| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF | | | | | | | | | | | | | | | | | | | | | |}}
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| {{familytree/end}}
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|
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|
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| {{familytree/start |summary=Sample 11}}{{familytree/start |summary=PE diagnosis Algorithm.}}
| |
| {{Family tree/start}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | | | | B01 | | | | | B01=<div style="float: left; text-align: left; height: 20em; width: 17em; padding:1em;"> '''Symptoms associated with Chest pain in children and adolescence:'''<br>
| |
| ----
| |
| ❑ [[Cough]] (23.4%) <br> ❑ [[Dyspnea]] (11%) <br> ❑ [[Abdominal pain]] (9.7%) <br> ❑ [[Palpitation]] (9.7%) <br> ❑ [[Respiratory related]] (9%) <br> ❑ [[Dizziness]] (5.8%)<br>❑ [[Post nasal drip]] (4.4%) <br>❑ [[Fever]] (5.2%) <br> ❑ [[Exercise induced]] (2.6%) <br>❑ [[Syncope]] (2.6%) <br></div>}}
| |
| {{familytree/end}}
| |
|
| |
| |}}
| |
| ----
| |
| ❑ [[Cough]] (23.4%) <br> ❑ [[Dyspnea]] (11%) <br> ❑ [[Abdominal pain]] (9.7%) <br> ❑ [[Palpitation]] (9.7%) <br> ❑ [[Respiratory related]] (9%) <br> ❑ [[Dizziness]] (5.8%)<br>❑ [[Post nasal drip]] (4.4%) <br>❑ [[Fever]] (5.2%) <br> ❑ [[Exercise induced]] (2.6%) <br>❑ [[Syncope]] (2.6%) <br></div>
| |
| }}
| |
| {{familytree/end}}
| |
|
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| {{Family tree/start}}
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| {{familytree | | | | | F01 | | | | | F01=<div style="float: left; text-align: left; height: 30em; width: 17em; padding:1em;"> '''Is there any red flag about cardiac etiology?:'''<br>
| |
| ----
| |
| ❑ History of acquired or [[congenital cardiac disease]] <br> ❑ Exertional [[syncope]] <br> ❑ Exertional [[chest pain]] <br> ❑ [[Hypercoagulable]] state <br> ❑ [[Hypercholesterolemic]] state ❑ [[Family history]] of [[sudden death]] under 35 years of age<br> ❑[[Family history]] of premature [[coronary artery disease]]<br>❑[[Inheritted arrhythmia]] in the first relative <br>❑[[ICD]] implantation <br>❑ [[Connective tissue disease]]<br>❑ Using [[cocaine]], [[amphetamine]]<br> </div>}}
| |
| {{familytree | | | | | |!| | | | | |}}
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| {{familytree | | | | | C01 | | | | | C01=<div style="float: left; text-align: left; height: 30em; width: 17em; padding:1em;"> '''Laboratory investigation in suspicion of [[cardiac ]] etiology:'''<br>
| |
| ----
| |
| ❑ [[EKG]] <br> ❑ [[CXR]]<br> ❑ [[Echocardiography]] <br> ❑ [[Holter monitoring]] <br>
| |
| ----
| |
| ❑ [[Exercise stress test]]<br> ❑ [[Dobutamin stress test]] <br> ❑ [[Thalium scan]] <br> ❑ [[Serum creatine kinase with MB fraction]] ❑ [[Serum troponineI]]<br> ❑[[Lipid ]]profile<br>❑[[Pericardiocenthesis]]<br>❑[[Endomyocardial biopsy]]<br>❑ [[Catheterization]]<br> </div>|}}
| |
| {{familytree/end}}
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|
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|
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| {{familytree/end}}
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|
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| {{familytree/start |summary=Sample 11}}{{familytree/start |summary=PE diagnosis Algorithm.}}
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| {{Family tree/start}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | | | | B01 | | | | | B01=<div style="float: left; text-align: left; height: 20em; width: 17em; padding:1em;"> '''Symptoms associated with Chest pain in children and adolescence:'''<br>
| |
| ----
| |
| ❑ [[Cough]] (23.4%) <br> ❑ [[Dyspnea]] (11%) <br> ❑ [[Abdominal pain]] (9.7%) <br> ❑ [[Palpitation]] (9.7%) <br> ❑ [[Respiratory related]] (9%) <br> ❑ [[Dizziness]] (5.8%)<br>❑ [[Post nasal drip]] (4.4%) <br>❑ [[Fever]] (5.2%) <br> ❑ [[Exercise induced]] (2.6%) <br>❑ [[Syncope]] (2.6%) <br></div>}}
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| {{familytree/end}}
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| {{familytree/start |summary=PE diagnosis Algorithm.}}
| |
| {{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=[[Cardiac]] |A02=Underlying congenital or acquired [[heart]] disease, [[arrhythmia]], [[crushing]] [[chest pain]], exercised induced [[chest pain]], [[persistent tachycardia]], [[hypotension]], [[gallop rhythm]], [[syncope]], [[pericardial rub]]|}}
| |
| {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
| |
| {{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=[[Pulmonary]] |B02= [[Hemoptysia]], [[tachypnea]], [[rales]],[[cyanosis]], [[ wheeze]], [[pleural rub]]|}}
| |
| {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
| |
| {{familytree | | | | | | C01 |-|+|-| C02 |-| C03 | | | |C01= [[Physical examination]] |C02=[[Gastrointestinal]] |C03=[[Hematemesis]],[[hematochezia]], [[melena]], [[epigastric tenderness]], [[organomegaly]], [[trauma]] }}
| |
| {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
| |
| {{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=[[musculoskeletal]]|B02= Chest [[Trauma]], [[chest]] [[bruising]], [[chest asymmetry]], [[chest]] localised [[swelling]], [[chest]] localized [[tenderness]], [[crepitus]] on [[palpation]], [[arm]] limited [[range of motion]]|}}
| |
| {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
| |
| {{familytree | | | | | | | | | |`|-| D01 |-| D02 | | | |D01=Other |D02= [[Febrile]], [[psychosis]], [[suisidal ideation]] }}
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| {{familytree/end}}
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| {{familytree/end}}
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| {{Family tree/start}}
| |
| {{Family tree| | | | | | | | A01 | | | |A01= Evaluation of [[chest pain]]}}
| |
| {{Family tree| | | | | | | | |!| | | | | }}
| |
| {{Family tree| | | | | | | | A02 | | | |A02=[[Medical history]], [[cardiac]] [[examination]] }}
| |
| {{Family tree| | | | | |,|-|-|^|-|-|.| | }}
| |
| {{Family tree| | | | | A03 | | | | A04 |-|-|.| | | | |A03= Abnormal [[history]] or [[cardiac]] [[examination]]| A04= Normal [[history]] and [[cardiac]] [[examination]]}}
| |
| {{Family tree| | | |,|-|^|-|-|.| | | | | | |!| | | |}}
| |
| {{Family tree| | | |A05| | |A06|-|-|.| | | |!| | | | |A05=Yes|A06=NO}}
| |
| {{Family tree| | | |!| | | | | | | | | |!| |!| | | |}}
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| {{Family tree| | | |A0 | | | | | |A9 |-|-|-|'| | | |A0=[[Febrile]], [[acute onset symptoms]]|A9=[[Palpitation]], [[chest pain]], positive [[family history]]}}
| |
| {{Family tree| |,|-|^|-|.| | | |,|-|^|-|.| |}}
| |
| {{Family tree| |A7 | | A8| |A10| |A11| | A7=Yes|A8=NO|A10=NO|A11=Yes|}}
| |
| {{Family tree| |!| | | |!| | | |!| | | | |!| |}}
| |
| {{Family tree| |B1 | | B2| | B3| | B4| | | | | | | |B1=<div style="float: left; text-align: left; width: 12em; padding:1em;">[[Myocarditis]],[[pericarditis]] <span style="font-size:85%;color:red">[[Fever|<span style="color:red">Fever,</span>]] [[rub|<span style="color:red">rub,</span>]] [[gallop|<span style="color:red">gallop,</span>]] [[abnormal vital sign|<span style="color:red">abnormal vital sign,</span>]] [[ill appearance|<span style="color:red">ill appearance</span>]]|B2=Refer to [[pediatric cardiologist]]|B4=Refer to pediatric cardiologist|B3=At rest [[chest pain]], [[exersional chest pain]]}}
| |
| {{Family tree| | | | | | | | | |,|-|^|-|.| |}}
| |
| {{Family tree| | | | | | | | | |C1 | | C2| | |C1=Exertional [[chest pain]]|C2=At rest [[chest pain]] or reproducible on exam }}
| |
| {{Family tree| | | | | | | | | |!| | | |!| |}}
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| {{Family tree| | | | | | | | | |D1 | | D2| |D1= Suspected [[asthma]]| D2=Low likehood of [[cardiac ]] [[chest pain]]}}
| |
| {{Family tree| | | | | | | |,|-|^|-|.| | |!|}}
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| {{Family tree| | | | | | | D3| | D4| | D5| | |D3=Yes |D4=NO|D5=Reassurance | | |}}
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| {{Family tree| | | | | | | |!| | |!| | | }}
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| {{Family tree| | | | | | | E1| | E2| | | | | |E1=[[Bronchodilator]]|E2=Refer to [[pediatric cardiologist]]}}
| |
| {{Family tree| | | | | | | |!| | | | | | }}
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| {{Family tree| | | | | | | |E3 | | | | | |E3=Improvement }}
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| {{Family tree| | | | | |,|-|^|-|.| | | | }}
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| {{Family tree| | | | | |F3 | |F4 | | | | |F3=Keeping management|F4=Refer to [[pediatric cardiologist]] }}
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| {{Family tree| | | | | | | | | | | | | | }}
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| {{Family tree| | | | | | | | | | | | | | }}
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| {{Family tree| | | | | | | | | | | | | | }}
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| {{Family tree| | | | | | | | | | | | | | }}
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| {{Family tree| | | | | | | | | | | | | | }}
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| {{Family tree| | | | | | | | | | | | | | }}
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| {{Family tree| | | | | | | | | | | | | | }}
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| {{Family tree| | | | | | | | | | | | | | }}
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| {{Family tree/end}}
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| {| class="wikitable"
| |
| |-
| |
| |- bgcolor="LightBlue"
| |
| |''' Causes of sharp chest pain'''
| |
| | bgcolor="LightBlue" |
| |
| '''Aspect'''
| |
| |-
| |
| |- bgcolor="LightBlue"
| |
| | Ideopathic (73.6%)
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| | bgcolor="LightBlue" |
| |
| *The most common cause
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| *Duration:2-3 minutes
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| * Normal [[Chest-X-Ray]] ([[CXR]]), [[ECG]] findings
| |
| |-
| |
| |- bgcolor="LightBlue"
| |
| |[[Respiratory]] (9.3%)
| |
| | bgcolor="LightBlue" |
| |
| *[[Asthma]]
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| *[[Acute bronchitis]]
| |
| *[[Pneumonia]]
| |
| *[[Pneumomediastinum]]
| |
| *[[Pneumothorax]]
| |
| |-
| |
| |- bgcolor="LightBlue"
| |
| |[[Musculoskeletal]] (8.8%)
| |
| | bgcolor="LightBlue" |
| |
| * [[Chest wall tenderness]]
| |
| * [[Osteomyelitis of sternum]]
| |
| |-
| |
| |-
| |
| |- bgcolor="LightBlue"
| |
| |[[Cardiac]] (3.8%)
| |
| | bgcolor="LightBlue" |
| |
| * [[ASD]]
| |
| *[[Pulmonary artery stenosis]]
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| *[[VSD]]
| |
| *[[Aortic arch anomaly]]
| |
| * Large [[PDA]] with [[eisenmenger]]
| |
| *[[Arrhythmia]]
| |
| |-
| |
| |-
| |
| |- bgcolor="LightBlue"
| |
| |[[Gastrointestinal]] (2.9%)
| |
| | bgcolor="LightBlue" |
| |
| *[[Gastritis]]
| |
| *[[GERD]]
| |
| *Acute [[gastroenteritis]]
| |
| *[[Dyspepsia]]
| |
| |- bgcolor="LightBlue"
| |
| |[[Psychiatric]] (1.4%)
| |
| | bgcolor="LightBlue" |
| |
| * [[Anxiety disorder]]
| |
| *[[Panic disorder]]
| |
| |-
| |
| |}
| |
| {| class="wikitable" style="margin: 1em auto 1em auto"
| |
| |+ '''Red flag related cardiac etiology of chest pain'''
| |
| ! Cardiac origin
| |
| |-
| |
| | History of acquired or [[congenital cardiac disease]]
| |
| |-
| |
| | Exertional [[syncope]]
| |
| |-
| |
| |Exertional [[chest pain]]
| |
| |-
| |
| |[[Hypercoagulable]] state
| |
| |-
| |
| |[[Hypercholesterolemic]] state
| |
| |-
| |
| |Family history of [[sudden death]] under 35 years of age
| |
| |-
| |
| |Family history of premature [[coronary artery disease]]
| |
| |-
| |
| |[[Inheritted arrhythmia]] in the first relative
| |
| |-
| |
| |[[ICD]] implantation
| |
| |-
| |
| |[[Connective tissue disease]]
| |
| |-
| |
| | Using [[cocaine]],[[amphetamine]]
| |
| |-
| |
| |}
| |
| {{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}}
| |
| {{Family tree/start}}
| |
| {{familytree | | | | | B01 | | | | | B01=<div style="float: left; text-align: left; height: 30em; width: 17em; padding:1em;"> '''Is there any red flag about cardiac etiology?:'''<br>
| |
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| ❑ History of acquired or [[congenital cardiac disease]] <br> ❑ Exertional [[syncope]] <br> ❑ Exertional [[chest pain]] <br> ❑ [[Hypercoagulable]] state <br> ❑ [[Hypercholesterolemic]] state ❑ [[Family history]] of [[sudden death]] under 35 years of age<br> ❑[[Family history]] of premature [[coronary artery disease]]<br>❑[[Inheritted arrhythmia]] in the first relative <br>❑[[ICD]] implantation <br>❑ [[Connective tissue disease]]<br>❑ Using [[cocaine]], [[amphetamine]]<br> </div>}}
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| {{familytree | | | | | C01 | | | | | C01=<div style="float: left; text-align: left; height: 30em; width: 17em; padding:1em;"> '''Laboratory investigation in suspicion of [[cardiac ]] etiology:'''<br>
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| ❑ [[EKG]] <br> ❑ [[CXR]]<br> ❑ [[Echocardiography]] <br> ❑ [[Holter monitoring]] <br>
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| ❑ [[Exercise stress test]]<br> ❑ [[Dobutamin stress test]] <br> ❑ [[Thalium scan]] <br> ❑ [[Serum creatine kinase with MB fraction]] ❑ [[Serum troponineI]]<br> ❑[[Lipid ]]profile<br>❑[[Pericardiocenthesis]]<br>❑[[Endomyocardial biopsy]]<br>❑ [[Catheterization]]<br> </div>}}
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| ==Treatment== | | ==Treatment== |