Cardiogenic shock differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Cardiogenic shock}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Cardiogenic_shock]]
{{CMG}}; {{AE}} {{JS}} {{sali}}
{{CMG}}; {{AE}} {{JS}} {{sali}} {{RG}}


==Overview==
==Overview==
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::*More than a simple loss of [[intravascular]] volume, [[hypovolemic shock]] is a dynamic process in which the responses to the initial insult, and the period of time during which they are in practice, will dictate the response to treatment and therefore the [[outcome]]. Several causes may be in the origin of this type of [[shock]], including: [[hemorrhage]], [[dehydration]], [[GI]] or [[urinary]] losses and severe [[vasodilation|venodilation]] (in the setting of other conditions). There is a relationship between the clinical status of the patient and the amount of circulating [[blood]] volume, the [[signs]] may include  [[pallor]], [[cool extremities]], [[tachycardia]] and [[tachypnea]], [[oliguria]] and decreased [[consciousness]]. Compensatory mechanisms are responsible for tolerating initial [[blood loss]], however they begin to fail after about 20-25% of [[blood]] has been lost. This tolerance will be dictated mostly by the previous [[cardiac]] reserve of the patient, along with the velocity of loss of [[intravascular]] volume<ref name="pmid29404656">{{cite journal |vauthors=Lier H, Bernhard M, Hossfeld B |title=[Hypovolemic and hemorrhagic shock] |language=German |journal=Anaesthesist |volume=67 |issue=3 |pages=225–244 |date=March 2018 |pmid=29404656 |doi=10.1007/s00101-018-0411-z |url=}}</ref><ref name="pmid23153876">{{cite journal |vauthors=Kobayashi L, Costantini TW, Coimbra R |title=Hypovolemic shock resuscitation |journal=Surg. Clin. North Am. |volume=92 |issue=6 |pages=1403–23 |date=December 2012 |pmid=23153876 |doi=10.1016/j.suc.2012.08.006 |url=}}</ref>.
::*More than a simple loss of [[intravascular]] volume, [[hypovolemic shock]] is a dynamic process in which the responses to the initial insult, and the period of time during which they are in practice, will dictate the response to treatment and therefore the [[outcome]]. Several causes may be in the origin of this type of [[shock]], including: [[hemorrhage]], [[dehydration]], [[GI]] or [[urinary]] losses and severe [[vasodilation|venodilation]] (in the setting of other conditions). There is a relationship between the clinical status of the patient and the amount of circulating [[blood]] volume, the [[signs]] may include  [[pallor]], [[cool extremities]], [[tachycardia]] and [[tachypnea]], [[oliguria]] and decreased [[consciousness]]. Compensatory mechanisms are responsible for tolerating initial [[blood loss]], however they begin to fail after about 20-25% of [[blood]] has been lost. This tolerance will be dictated mostly by the previous [[cardiac]] reserve of the patient, along with the velocity of loss of [[intravascular]] volume<ref name="pmid29404656">{{cite journal |vauthors=Lier H, Bernhard M, Hossfeld B |title=[Hypovolemic and hemorrhagic shock] |language=German |journal=Anaesthesist |volume=67 |issue=3 |pages=225–244 |date=March 2018 |pmid=29404656 |doi=10.1007/s00101-018-0411-z |url=}}</ref><ref name="pmid23153876">{{cite journal |vauthors=Kobayashi L, Costantini TW, Coimbra R |title=Hypovolemic shock resuscitation |journal=Surg. Clin. North Am. |volume=92 |issue=6 |pages=1403–23 |date=December 2012 |pmid=23153876 |doi=10.1016/j.suc.2012.08.006 |url=}}</ref>.
::*When comparing [[hypovolemic shock|hypovolemic]] and [[cardiogenic shock]] (most commonly complicating acute-[[MI]]) some specific clinical [[signs]] of [[shock]] will be similar, however, others will be different, particularly [[signs]] of [[CHF]], such as the presence of distended [[jugular]] and peripheral [[veins]], presence of an [[S3]] sound and [[pulmonary edema]] on the cardiogenic type.
::*When comparing [[hypovolemic shock|hypovolemic]] and [[cardiogenic shock]] (most commonly complicating acute-[[MI]]) some specific clinical [[signs]] of [[shock]] will be similar, however, others will be different, particularly [[signs]] of [[CHF]], such as the presence of distended [[jugular]] and peripheral [[veins]], presence of an [[S3]] sound and [[pulmonary edema]] on the cardiogenic type.
::*When comparing [[hemodynamic]] data, similarities include: decreased [[cardiac index]], [[stroke volume]] index, [[cardiac output]], mixed [[venous]] [[oxygen saturation]] and increased difference in arteriovenous O<sub>2</sub> saturation and [[SVR]]. Differences to be noted include: decreased [[ventricular]] [[preload]], [[ventricular]] [[diastolic]] volumes and pressures, [[pulmonary wedge pressure]] and [[central venous pressure]].
::*When comparing [[hemodynamic]] data, similarities include: decreased [[cardiac index]], [[stroke volume]] index, [[cardiac output]], mixed [[venous]] [[oxygen saturation]] and increased difference in arteriovenous O<sub>2</sub> saturation and [[SVR]].  
Differences to be noted include:  
:<math>\mbox{Shock index} = \frac{heart\ rate}{systolic\ blood\ pressure}</math>
 
Other measures include:
decreased [[ventricular]] [[preload]], [[ventricular]] [[diastolic]] volumes and pressures, [[pulmonary wedge pressure]] and [[central venous pressure]].
::*When treating [[hypovolemic shock]] it's mandatory to rule out [[cardiogenic]] cause because part of the treatment for [[hypovolemic shock]], urgent [[intravascular]] volume replacement, may further jeopardize the [[cardiac]] condition in the cardiogenic form.
::*When treating [[hypovolemic shock]] it's mandatory to rule out [[cardiogenic]] cause because part of the treatment for [[hypovolemic shock]], urgent [[intravascular]] volume replacement, may further jeopardize the [[cardiac]] condition in the cardiogenic form.


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::*The hallmark of this form of [[shock]] is the decrease of [[peripheral resistance]]. This may be present in a series of conditions that may lead to [[distributive shock]], such as: [[sepsis]], [[anaphylaxis]], [[toxic shock syndrome]] and [[adrenal crisis]].
::*The hallmark of this form of [[shock]] is the decrease of [[peripheral resistance]]. This may be present in a series of conditions that may lead to [[distributive shock]], such as: [[sepsis]], [[anaphylaxis]], [[toxic shock syndrome]] and [[adrenal crisis]].
::*When compared to [[cardiogenic shock]] it presents with similarities, such as: decreased [[cardiac index]], left and right [[ventricular]] stroke work and increased [[serum]] [[lactate]]. The differences reside in: overall decreased of [[SVR]], which after fluid resuscitation may become elevated, [[ventricular]] filling pressure, difference in arteriovenous O<sub>2</sub> saturation and increase of mixed [[venous]] [[oxygen saturation]]. It is important to note that, unlike [[cardiogenic shock|cardiogenic]] and other types of [[shock]], in the [[distributive shock|distributive]] kind there is an increase in [[venous]] [[oxygen saturation]] which, despite the increased O<sub>2</sub> demand, might be due to the increased total body [[perfusion]], that is responsible for diminishing the effectiveness of individual tissue [[perfusion]]<ref name="pmid29261964">{{cite journal |vauthors=Smith N, Lopez RA, Silberman M |title= |journal= |volume= |issue= |pages= |date= |pmid=29261964 |doi= |url=}}</ref><ref name="pmid28238385">{{cite journal |vauthors=Alyeşil C, Doğan NÖ, Özturan İU, Güney S |title=Distributive Shock in the Emergency Department: Sepsis, Anaphylaxis, or Capillary Leak Syndrome? |journal=J Emerg Med |volume=52 |issue=6 |pages=e229–e231 |date=June 2017 |pmid=28238385 |doi=10.1016/j.jemermed.2017.01.012 |url=}}</ref><ref name="pmid17493496">{{cite journal |vauthors=Brown SG |title=The pathophysiology of shock in anaphylaxis |journal=Immunol Allergy Clin North Am |volume=27 |issue=2 |pages=165–75, v |date=May 2007 |pmid=17493496 |doi=10.1016/j.iac.2007.03.003 |url=}}</ref>.
::*When compared to [[cardiogenic shock]] it presents with similarities, such as: decreased [[cardiac index]], left and right [[ventricular]] stroke work and increased [[serum]] [[lactate]]. The differences reside in: overall decreased of [[SVR]], which after fluid resuscitation may become elevated, [[ventricular]] filling pressure, difference in arteriovenous O<sub>2</sub> saturation and increase of mixed [[venous]] [[oxygen saturation]]. It is important to note that, unlike [[cardiogenic shock|cardiogenic]] and other types of [[shock]], in the [[distributive shock|distributive]] kind there is an increase in [[venous]] [[oxygen saturation]] which, despite the increased O<sub>2</sub> demand, might be due to the increased total body [[perfusion]], that is responsible for diminishing the effectiveness of individual tissue [[perfusion]]<ref name="pmid29261964">{{cite journal |vauthors=Smith N, Lopez RA, Silberman M |title= |journal= |volume= |issue= |pages= |date= |pmid=29261964 |doi= |url=}}</ref><ref name="pmid28238385">{{cite journal |vauthors=Alyeşil C, Doğan NÖ, Özturan İU, Güney S |title=Distributive Shock in the Emergency Department: Sepsis, Anaphylaxis, or Capillary Leak Syndrome? |journal=J Emerg Med |volume=52 |issue=6 |pages=e229–e231 |date=June 2017 |pmid=28238385 |doi=10.1016/j.jemermed.2017.01.012 |url=}}</ref><ref name="pmid17493496">{{cite journal |vauthors=Brown SG |title=The pathophysiology of shock in anaphylaxis |journal=Immunol Allergy Clin North Am |volume=27 |issue=2 |pages=165–75, v |date=May 2007 |pmid=17493496 |doi=10.1016/j.iac.2007.03.003 |url=}}</ref>.
 
<small><small>
{| style="border: 8px solid #A8A8A8; font-size: 180%;" align="center"
{| style="border: 8px solid #A8A8A8; font-size: 180%;" align="center"
|+ <SMALL>''Classification of shock based on hemodynamic parameters.'' (CO, cardiac output; CVP; central venous pressure; PAD, pulmonary artery diastolic pressure; PAS, pulmonary artery systolic pressure; RVD, right ventricular diastolic pressure; RVS, right ventricular systolic pressure; SVO2, systemic venous oxygen saturation; SVR, systemic vascular resistance.)<ref name="isbn0-683-06754-0">{{Cite book  | last1 = Parrillo | first1 = Joseph E. | last2 = Ayres | first2 = Stephen M. | title = Major issues in critical care medicine | date = 1984 | publisher = William  Wilkins | location = Baltimore | isbn = 0-683-06754-0 | pages =  }}</ref><ref name="isbn9781405179263">{{cite book | author = Judith S. Hochman, E. Magnus Ohman | authorlink = | editor = | others = | title = Cardiogenic Shock | edition = | language = | publisher = Wiley-Blackwell | location = | year = 2009 | origyear = | pages = | quote = | isbn = 9781405179263 | oclc = | doi = | url = | accessdate = }}</ref></SMALL>
|+ ''Classification of shock based on hemodynamic parameters.'' (CO, cardiac output; CVP; central venous pressure; PAD, pulmonary artery diastolic pressure; PAS, pulmonary artery systolic pressure; RVD, right ventricular diastolic pressure; RVS, right ventricular systolic pressure; SVO2, systemic venous oxygen saturation; SVR, systemic vascular resistance.)<ref name="isbn0-683-06754-0">{{Cite book  | last1 = Parrillo | first1 = Joseph E. | last2 = Ayres | first2 = Stephen M. | title = Major issues in critical care medicine | date = 1984 | publisher = William  Wilkins | location = Baltimore | isbn = 0-683-06754-0 | pages =  }}</ref><ref name="isbn9781405179263">{{cite book | author = Judith S. Hochman, E. Magnus Ohman | authorlink = | editor = | others = | title = Cardiogenic Shock | edition = | language = | publisher = Wiley-Blackwell | location = | year = 2009 | origyear = | pages = | quote = | isbn = 9781405179263 | oclc = | doi = | url = | accessdate = }}</ref>
| align="center" style="background: #A8A8A8; width: 100px;"| '''Type of Shock'''
| align="center" style="background: #A8A8A8; width: 100px;"| '''Type of Shock'''
| align="center" style="background: #A8A8A8; width: 50px;" | '''Etiology'''
| align="center" style="background: #A8A8A8; width: 50px;" | '''Etiology'''
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'''The following table outlines the major differential diagnoses of Shock on the basis of clinical manifestations.'''.<ref name="pmid8704488">{{cite journal |vauthors=Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K |title=Chest pain in family practice. Diagnosis and long-term outcome in a community setting |journal=Can Fam Physician |volume=42 |issue= |pages=1122–8 |date=June 1996 |pmid=8704488 |pmc=2146490 |doi= |url=}}</ref><ref name="pmid8163958">{{cite journal |vauthors=Klinkman MS, Stevens D, Gorenflo DW |title=Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network |journal=J Fam Pract |volume=38 |issue=4 |pages=345–52 |date=April 1994 |pmid=8163958 |doi= |url=}}</ref><ref name="pmid19883149">{{cite journal |vauthors=Bösner S, Becker A, Haasenritter J, Abu Hani M, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Seitz G, Baum E, Donner-Banzhoff N |title=Chest pain in primary care: epidemiology and pre-work-up probabilities |journal=Eur J Gen Pract |volume=15 |issue=3 |pages=141–6 |date= 2009 |pmid=19883149 |doi=10.3109/13814780903329528 |url=}}</ref><ref name="pmid21391528">{{cite journal |vauthors=Ebell MH |title=Evaluation of chest pain in primary care patients |journal=Am Fam Physician |volume=83 |issue=5 |pages=603–5 |date=March 2011 |pmid=21391528 |doi= |url=}}</ref><ref name="pmid11041906">{{cite journal |vauthors=von Kodolitsch Y, Schwartz AG, Nienaber CA |title=Clinical prediction of acute aortic dissection |journal=Arch. Intern. Med. |volume=160 |issue=19 |pages=2977–82 |date=October 2000 |pmid=11041906 |doi= |url=}}</ref><ref name="pmid2730190">{{cite journal |vauthors=Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH |title=Spontaneous rupture of the esophagus: a 30-year experience |journal=Ann. Thorac. Surg. |volume=47 |issue=5 |pages=689–92 |date=May 1989 |pmid=2730190 |doi= |url=}}</ref><ref name="pmid7954018">{{cite journal |vauthors=Fleet RP, Dupuis G, Marchand A, Burelle D, Beitman BD |title=Panic disorder, chest pain and coronary artery disease: literature review |journal=Can J Cardiol |volume=10 |issue=8 |pages=827–34 |date=October 1994 |pmid=7954018 |doi= |url=}}</ref><ref name="pmid3270082">{{cite journal |vauthors=Bass C, Chambers JB, Kiff P, Cooper D, Gardner WN |title=Panic anxiety and hyperventilation in patients with chest pain: a controlled study |journal=Q. J. Med. |volume=69 |issue=260 |pages=949–59 |date=December 1988 |pmid=3270082 |doi= |url=}}</ref><ref name="pmid64694">{{cite journal |vauthors=Evans DW, Lum LC |title=Hyperventilation: An important cause of pseudoangina |journal=Lancet |volume=1 |issue=8004 |pages=155–7 |date=January 1977 |pmid=64694 |doi= |url=}}</ref><ref name="pmid9246027">{{cite journal |vauthors=Ros E, Armengol X, Grande L, Toledo-Pimentel V, Lacima G, Sanz G |title=Chest pain at rest in patients with coronary artery disease. Myocardial ischemia, esophageal dysfunction, or panic disorder? |journal=Dig. Dis. Sci. |volume=42 |issue=7 |pages=1344–53 |date=July 1997 |pmid=9246027 |doi= |url=}}</ref><ref name="pmid9594945">{{cite journal |vauthors=Ben Freedman S, Tennant CC |title=Panic disorder and coronary artery spasm |journal=Med. J. Aust. |volume=168 |issue=8 |pages=376–7 |date=April 1998 |pmid=9594945 |doi= |url=}}</ref><ref name="pmid17909127">{{cite journal |vauthors=Smoller JW, Pollack MH, Wassertheil-Smoller S, Jackson RD, Oberman A, Wong ND, Sheps D |title=Panic attacks and risk of incident cardiovascular events among postmenopausal women in the Women's Health Initiative Observational Study |journal=Arch. Gen. Psychiatry |volume=64 |issue=10 |pages=1153–60 |date=October 2007 |pmid=17909127 |doi=10.1001/archpsyc.64.10.1153 |url=}}</ref><ref name="pmid12426266">{{cite journal |vauthors=Mehta NJ, Khan IA |title=Cardiac Munchausen syndrome |journal=Chest |volume=122 |issue=5 |pages=1649–53 |date=November 2002 |pmid=12426266 |doi= |url=}}</ref><ref name="pmid16304077">{{cite journal |vauthors=Swap CJ, Nagurney JT |title=Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes |journal=JAMA |volume=294 |issue=20 |pages=2623–9 |date=November 2005 |pmid=16304077 |doi=10.1001/jama.294.20.2623 |url=}}</ref><ref name="pmid17208083">{{cite journal |vauthors=Marcus GM, Cohen J, Varosy PD, Vessey J, Rose E, Massie BM, Chatterjee K, Waters D |title=The utility of gestures in patients with chest discomfort |journal=Am. J. Med. |volume=120 |issue=1 |pages=83–9 |date=January 2007 |pmid=17208083 |doi=10.1016/j.amjmed.2006.05.045 |url=}}</ref><ref name="pmid17850647">{{cite journal |vauthors=Verdon F, Burnand B, Herzig L, Junod M, Pécoud A, Favrat B |title=Chest wall syndrome among primary care patients: a cohort study |journal=BMC Fam Pract |volume=8 |issue= |pages=51 |date=September 2007 |pmid=17850647 |pmc=2072948 |doi=10.1186/1471-2296-8-51 |url=}}</ref><ref name="pmid4086742">{{cite journal |vauthors=Davies HA, Jones DB, Rhodes J, Newcombe RG |title=Angina-like esophageal pain: differentiation from cardiac pain by history |journal=J. Clin. Gastroenterol. |volume=7 |issue=6 |pages=477–81 |date=December 1985 |pmid=4086742 |doi= |url=}}</ref><ref name="pmid9786377">{{cite journal |vauthors=Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL |title=The rational clinical examination. 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'''The following table outlines the major differential diagnoses of Shock on the basis of clinical manifestations.'''.<ref name="pmid8704488">{{cite journal |vauthors=Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K |title=Chest pain in family practice. Diagnosis and long-term outcome in a community setting |journal=Can Fam Physician |volume=42 |issue= |pages=1122–8 |date=June 1996 |pmid=8704488 |pmc=2146490 |doi= |url=}}</ref><ref name="pmid8163958">{{cite journal |vauthors=Klinkman MS, Stevens D, Gorenflo DW |title=Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network |journal=J Fam Pract |volume=38 |issue=4 |pages=345–52 |date=April 1994 |pmid=8163958 |doi= |url=}}</ref><ref name="pmid19883149">{{cite journal |vauthors=Bösner S, Becker A, Haasenritter J, Abu Hani M, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Seitz G, Baum E, Donner-Banzhoff N |title=Chest pain in primary care: epidemiology and pre-work-up probabilities |journal=Eur J Gen Pract |volume=15 |issue=3 |pages=141–6 |date= 2009 |pmid=19883149 |doi=10.3109/13814780903329528 |url=}}</ref><ref name="pmid21391528">{{cite journal |vauthors=Ebell MH |title=Evaluation of chest pain in primary care patients |journal=Am Fam Physician |volume=83 |issue=5 |pages=603–5 |date=March 2011 |pmid=21391528 |doi= |url=}}</ref><ref name="pmid11041906">{{cite journal |vauthors=von Kodolitsch Y, Schwartz AG, Nienaber CA |title=Clinical prediction of acute aortic dissection |journal=Arch. Intern. Med. |volume=160 |issue=19 |pages=2977–82 |date=October 2000 |pmid=11041906 |doi= |url=}}</ref><ref name="pmid2730190">{{cite journal |vauthors=Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH |title=Spontaneous rupture of the esophagus: a 30-year experience |journal=Ann. Thorac. Surg. |volume=47 |issue=5 |pages=689–92 |date=May 1989 |pmid=2730190 |doi= |url=}}</ref><ref name="pmid7954018">{{cite journal |vauthors=Fleet RP, Dupuis G, Marchand A, Burelle D, Beitman BD |title=Panic disorder, chest pain and coronary artery disease: literature review |journal=Can J Cardiol |volume=10 |issue=8 |pages=827–34 |date=October 1994 |pmid=7954018 |doi= |url=}}</ref><ref name="pmid3270082">{{cite journal |vauthors=Bass C, Chambers JB, Kiff P, Cooper D, Gardner WN |title=Panic anxiety and hyperventilation in patients with chest pain: a controlled study |journal=Q. J. 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Med. |volume=120 |issue=1 |pages=83–9 |date=January 2007 |pmid=17208083 |doi=10.1016/j.amjmed.2006.05.045 |url=}}</ref><ref name="pmid17850647">{{cite journal |vauthors=Verdon F, Burnand B, Herzig L, Junod M, Pécoud A, Favrat B |title=Chest wall syndrome among primary care patients: a cohort study |journal=BMC Fam Pract |volume=8 |issue= |pages=51 |date=September 2007 |pmid=17850647 |pmc=2072948 |doi=10.1186/1471-2296-8-51 |url=}}</ref><ref name="pmid4086742">{{cite journal |vauthors=Davies HA, Jones DB, Rhodes J, Newcombe RG |title=Angina-like esophageal pain: differentiation from cardiac pain by history |journal=J. Clin. Gastroenterol. |volume=7 |issue=6 |pages=477–81 |date=December 1985 |pmid=4086742 |doi= |url=}}</ref><ref name="pmid9786377">{{cite journal |vauthors=Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL |title=The rational clinical examination. Is this patient having a myocardial infarction? |journal=JAMA |volume=280 |issue=14 |pages=1256–63 |date=October 1998 |pmid=9786377 |doi= |url=}}</ref><ref name="pmid2313224">{{cite journal |vauthors=Berger JP, Buclin T, Haller E, Van Melle G, Yersin B |title=Right arm involvement and pain extension can help to differentiate coronary diseases from chest pain of other origin: a prospective emergency ward study of 278 consecutive patients admitted for chest pain |journal=J. Intern. Med. |volume=227 |issue=3 |pages=165–72 |date=March 1990 |pmid=2313224 |doi= |url=}}</ref><ref name="pmid11676323">{{cite journal |vauthors=Yelland MJ |title=Back, chest and abdominal pain. How good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain? |journal=Aust Fam Physician |volume=30 |issue=9 |pages=908–12 |date=September 2001 |pmid=11676323 |doi= |url=}}</ref><ref name="pmid24791662">{{cite journal |vauthors=Chan S, Maurice AP, Davies SR, Walters DL |title=The use of gastrointestinal cocktail for differentiating gastro-oesophageal reflux disease and acute coronary syndrome in the emergency setting: a systematic review |journal=Heart Lung Circ |volume=23 |issue=10 |pages=913–23 |date=October 2014 |pmid=24791662 |doi=10.1016/j.hlc.2014.03.030 |url=}}</ref><ref name="pmid14678917">{{cite journal |vauthors=Henrikson CA, Howell EE, Bush DE, Miles JS, Meininger GR, Friedlander T, Bushnell AC, Chandra-Strobos N |title=Chest pain relief by nitroglycerin does not predict active coronary artery disease |journal=Ann. Intern. Med. |volume=139 |issue=12 |pages=979–86 |date=December 2003 |pmid=14678917 |doi= |url=}}</ref><ref name="pmid6638047">{{cite journal |vauthors=Pryor DB, Harrell FE, Lee KL, Califf RM, Rosati RA |title=Estimating the likelihood of significant coronary artery disease |journal=Am. J. Med. |volume=75 |issue=5 |pages=771–80 |date=November 1983 |pmid=6638047 |doi= |url=}}</ref><ref name="pmid11739341">{{cite journal |vauthors=Buntinx F, Knockaert D, Bruyninckx R, de Blaey N, Aerts M, Knottnerus JA, Delooz H |title=Chest pain in general practice or in the hospital emergency department: is it the same? |journal=Fam Pract |volume=18 |issue=6 |pages=586–9 |date=December 2001 |pmid=11739341 |doi= |url=}}</ref><ref name="pmid4006491">{{cite journal |vauthors=Tierney WM, Roth BJ, Psaty B, McHenry R, Fitzgerald J, Stump DL, Anderson FK, Ryder KW, McDonald CJ, Smith DM |title=Predictors of myocardial infarction in emergency room patients |journal=Crit. Care Med. |volume=13 |issue=7 |pages=526–31 |date=July 1985 |pmid=4006491 |doi= |url=}}</ref><ref name="pmid17101942">{{cite journal |vauthors=Sequist TD, Marshall R, Lampert S, Buechler EJ, Lee TH |title=Missed opportunities in the primary care management of early acute ischemic heart disease |journal=Arch. Intern. Med. |volume=166 |issue=20 |pages=2237–43 |date=November 2006 |pmid=17101942 |doi=10.1001/archinte.166.20.2237 |url=}}</ref><ref name="pmid1739527">{{cite journal |vauthors=Norell M, Lythall D, Coghlan G, Cheng A, Kushwaha S, Swan J, Ilsley C, Mitchell A |title=Limited value of the resting electrocardiogram in assessing patients with recent onset chest pain: lessons from a chest pain clinic |journal=Br Heart J |volume=67 |issue=1 |pages=53–6 |date=January 1992 |pmid=1739527 |pmc=1024701 |doi= |url=}}</ref><ref name="pmid16868579">{{cite journal |vauthors=Law K, Elley R, Tietjens J, Mann S |title=Troponin testing for chest pain in primary healthcare: a survey of its use by general practitioners in New Zealand |journal=N. Z. Med. J. |volume=119 |issue=1238 |pages=U2082 |date=July 2006 |pmid=16868579 |doi= |url=}}</ref><ref name="pmid9669056">{{cite journal |vauthors=Wilhelmsen L, Rosengren A, Hagman M, Lappas G |title="Nonspecific" chest pain associated with high long-term mortality: results from the primary prevention study in Göteborg, Sweden |journal=Clin Cardiol |volume=21 |issue=7 |pages=477–82 |date=July 1998 |pmid=9669056 |doi= |url=}}</ref><ref name="pmid16461444">{{cite journal |vauthors=Ruigómez A, Rodríguez LA, Wallander MA, Johansson S, Jones R |title=Chest pain in general practice: incidence, comorbidity and mortality |journal=Fam Pract |volume=23 |issue=2 |pages=167–74 |date=April 2006 |pmid=16461444 |doi=10.1093/fampra/cmi124 |url=}}</ref><ref name="pmid17199456">{{cite journal |vauthors=Robinson JG, Wallace R, Limacher M, Sato A, Cochrane B, Wassertheil-Smoller S, Ockene JK, Blanchette PL, Ko MG |title=Elderly women diagnosed with nonspecific chest pain may be at increased cardiovascular risk |journal=J Womens Health (Larchmt) |volume=15 |issue=10 |pages=1151–60 |date=December 2006 |pmid=17199456 |doi=10.1089/jwh.2006.15.1151 |url=}}</ref><ref name="pmid18180659">{{cite journal |vauthors=Geraldine McMahon C, Yates DW, Hollis S |title=Unexpected mortality in patients discharged from the emergency department following an episode of nontraumatic chest pain |journal=Eur J Emerg Med |volume=15 |issue=1 |pages=3–8 |date=February 2008 |pmid=18180659 |doi=10.1097/MEJ.0b013e32827b14cd |url=}}</ref><ref name="pmid20380960">{{cite journal |vauthors=Yelland M, Cayley WE, Vach W |title=An algorithm for the diagnosis and management of chest pain in primary care |journal=Med. 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Med. |volume=160 |issue=6 |pages=844–52 |date=March 2000 |pmid=10737285 |doi= |url=}}</ref><ref name="pmid24207111">{{cite journal |vauthors=Wertli MM, Ruchti KB, Steurer J, Held U |title=Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis |journal=BMC Med |volume=11 |issue= |pages=239 |date=November 2013 |pmid=24207111 |pmc=4226211 |doi=10.1186/1741-7015-11-239 |url=}}</ref>


<small><small>
 
'''''Abbreviations:''''' '''ABG ('''[[arterial blood gas]]'''); ACE ('''[[Angiotensin-converting enzyme|angiotensin converting enzyme]]'''); BMI ('''[[body mass index]]'''); CBC ('''[[Complete blood counts|complete blood count]]'''); CSF ('''[[cerebrospinal fluid]]'''); CXR ('''[[chest X-ray]]'''); ECG ('''[[electrocardiogram]]'''); FEF ('''[[Spirometry|forced expiratory flow rate]]'''); FEV1 ('''[[forced expiratory volume]]'''); FVC ('''[[forced vital capacity]]'''); JVD ('''[[jugular vein distention]]''');''' '''MCV ('''[[mean corpuscular volume]]'''); Plt ('''[[platelet]]'''); RV ('''[[residual volume]]'''); SIADH ('''[[syndrome of inappropriate antidiuretic hormone]]'''); TSH ('''[[thyroid stimulating hormone]]'''); Vt ('''[[tidal volume]]''');''' '''WBC ('''[[White blood cells|white blood cell]]'''); Coronary CT angiography (CCTA); multidetector row scanners (MDCT); Cardiovascular magnetic resonance — CMRI; Myocardial perfusion imaging (MPI); single-photon emission CT (SPECT); Positron emission tomography (PET) scanning; Magnetic resonance (MR) angiography, Computed tomographic (CT) angiography, and Transesophageal echocardiography (TEE), late gadolinium enhancement (LGE); right ventricular hypertrophy (RVH), right atrial enlargement (RAE), functional tricuspid regurgitation (TR), Pulmonary artery systolic pressure (PASP; adenosine deaminase (ADA); Serum amyloid A (SAA), soluble interleukin-2 receptor (sIL2R); High-resolution CT (HRCT) scanning'''     
'''''Abbreviations:''''' '''ABG ('''[[arterial blood gas]]'''); ACE ('''[[Angiotensin-converting enzyme|angiotensin converting enzyme]]'''); BMI ('''[[body mass index]]'''); CBC ('''[[Complete blood counts|complete blood count]]'''); CSF ('''[[cerebrospinal fluid]]'''); CXR ('''[[chest X-ray]]'''); ECG ('''[[electrocardiogram]]'''); FEF ('''[[Spirometry|forced expiratory flow rate]]'''); FEV1 ('''[[forced expiratory volume]]'''); FVC ('''[[forced vital capacity]]'''); JVD ('''[[jugular vein distention]]''');''' '''MCV ('''[[mean corpuscular volume]]'''); Plt ('''[[platelet]]'''); RV ('''[[residual volume]]'''); SIADH ('''[[syndrome of inappropriate antidiuretic hormone]]'''); TSH ('''[[thyroid stimulating hormone]]'''); Vt ('''[[tidal volume]]''');''' '''WBC ('''[[White blood cells|white blood cell]]'''); Coronary CT angiography (CCTA); multidetector row scanners (MDCT); Cardiovascular magnetic resonance — CMRI; Myocardial perfusion imaging (MPI); single-photon emission CT (SPECT); Positron emission tomography (PET) scanning; Magnetic resonance (MR) angiography, Computed tomographic (CT) angiography, and Transesophageal echocardiography (TEE), late gadolinium enhancement (LGE); right ventricular hypertrophy (RVH), right atrial enlargement (RAE), functional tricuspid regurgitation (TR), Pulmonary artery systolic pressure (PASP; adenosine deaminase (ADA); Serum amyloid A (SAA), soluble interleukin-2 receptor (sIL2R); High-resolution CT (HRCT) scanning'''     
</small></small>
<small><small>
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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!Weight loss
!Weight loss
!Associated Features
!Associated Features
|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
|
|
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*CCTA combined with MPI
*CCTA combined with MPI
|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
! rowspan="11" |Cardiac
! rowspan="10" |Cardiac


|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
Line 579: Line 576:
!Associated Features
!Associated Features
|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
! rowspan="12" |Pulmonary  
! rowspan="5" |Pulmonary
!'''[[Pulmonary Embolism]]'''<ref name="pmid17904458">{{cite journal |vauthors=Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK |title=Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II |journal=Am. J. Med. |volume=120 |issue=10 |pages=871–9 |date=October 2007 |pmid=17904458 |pmc=2071924 |doi=10.1016/j.amjmed.2007.03.024 |url=}}</ref><ref name="pmid2332918">{{cite journal |vauthors= |title=Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED) |journal=JAMA |volume=263 |issue=20 |pages=2753–9 |date=1990 |pmid=2332918 |doi= |url=}}</ref>
!'''[[Pulmonary Embolism]]'''<ref name="pmid17904458">{{cite journal |vauthors=Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK |title=Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II |journal=Am. J. Med. |volume=120 |issue=10 |pages=871–9 |date=October 2007 |pmid=17904458 |pmc=2071924 |doi=10.1016/j.amjmed.2007.03.024 |url=}}</ref><ref name="pmid2332918">{{cite journal |vauthors= |title=Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED) |journal=JAMA |volume=263 |issue=20 |pages=2753–9 |date=1990 |pmid=2332918 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
Line 698: Line 695:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[CT scan]]
*[[CT scan]]
|- style="background: #DCDCDC; padding: 5px;" |
![[Pneumonia]]<ref name="pmid14683661">{{cite journal |vauthors=File TM |title=Community-acquired pneumonia |journal=Lancet |volume=362 |issue=9400 |pages=1991–2001 |date=December 2003 |pmid=14683661 |doi=10.1016/S0140-6736(03)15021-0 |url=}}</ref><ref name="pmid17278083">{{cite journal |vauthors=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=Clin. Infect. Dis. |volume=44 Suppl 2 |issue= |pages=S27–72 |date=March 2007 |pmid=17278083 |doi=10.1086/511159 |url=}}</ref><ref name="pmid25337751">{{cite journal |vauthors=Musher DM, Thorner AR |title=Community-acquired pneumonia |journal=N. Engl. J. Med. |volume=371 |issue=17 |pages=1619–28 |date=October 2014 |pmid=25337751 |doi=10.1056/NEJMra1312885 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[chronic]]
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |
*Dull
*Localized to side of lesion
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
*[[Altered mental status]]
*[[Tachycardia]]
*Rust-colored [[sputum]]
*Green [[sputum]]
*Red currant-jelly [[sputum]]
*[[Central cyanosis]]
| style="background: #F5F5F5; padding: 5px;" |
* Long hospital stay
* Ill contact exposure
* [[Aspiration]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Wheezing]]
*[[Rhonchi]]
*[[Rales]]
*[[Decreased breath sounds]]
*[[Pleural friction rub]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Arterial blood gases|Arterial blood gas]] : [[Hypoxia]], [[hypoxemia]]
*↑ [[Procalcitonin]]
*[[Leukocytosis]]
*[[Sputum culture|Sputum evaluation]]
*Positive blood cultures
| style="background: #F5F5F5; padding: 5px;" |
*[[Sinus tachycardia]]
*Nonspecific [[ST-segment]] or T-wave changes
| style="background: #F5F5F5; padding: 5px;" |
*[[CXR]]: [[Interstitial infiltrates]], [[lobar]] consolidation, [[cavitation]] 
| style="background: #F5F5F5; padding: 5px;" |
*[[CXR]]
|- style="background: #DCDCDC; padding: 5px;" |
![[Tracheitis]]/ [[Bronchitis]]<ref name="pmid8327305">{{cite journal |vauthors=Conley SF, Beste DJ, Hoffmann RG |title=Measles-associated bacterial tracheitis |journal=Pediatr. Infect. Dis. J. |volume=12 |issue=5 |pages=414–5 |date=May 1993 |pmid=8327305 |doi= |url=}}</ref><ref name="pmid15577783">{{cite journal |vauthors=Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH |title=Bacterial tracheitis reexamined: is there a less severe manifestation? |journal=Otolaryngol Head Neck Surg |volume=131 |issue=6 |pages=871–6 |date=December 2004 |pmid=15577783 |doi=10.1016/j.otohns.2004.06.708 |url=}}</ref><ref name="pmid17015531">{{cite journal |vauthors=Hopkins A, Lahiri T, Salerno R, Heath B |title=Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis |journal=Pediatrics |volume=118 |issue=4 |pages=1418–21 |date=October 2006 |pmid=17015531 |doi=10.1542/peds.2006-0692 |url=}}</ref><ref name="pmid6869336">{{cite journal |vauthors=Liston SL, Gehrz RC, Siegel LG, Tilelli J |title=Bacterial tracheitis |journal=Am. J. Dis. Child. |volume=137 |issue=8 |pages=764–7 |date=August 1983 |pmid=6869336 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |
*Dull
*[[Substernal]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Tachypnea]]
*[[Respiratory distress]]
*[[Hoarseness]]
*[[Dyspnea]]
*[[Cyanosis]]
*[[Sore throat]]
*[[Odynophagia]]
*[[Dysphonia]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Aspiration]]
* [[Pneumonia]]
| style="background: #F5F5F5; padding: 5px;" |
*Inspiratory [[stridor]] (with or without expiratory [[Stridor|stridor)]]
*Nasal flaring
*[[Wheezing]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Gram stain]] of [[exudates]]: [[Neutrophils]]
| style="background: #F5F5F5; padding: 5px;" |
*Peaked P-wave
| style="background: #F5F5F5; padding: 5px;" |
*Radiography of the neck: [[Steeple sign]]
*[[Laryngotracheobronchoscopy]]: a normal [[epiglottis]] with [[subglottic]] narrowing, thick and purulent secretions in the [[trachea]], [[pseudomembranes]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Endoscopy]]
|- style="background: #DCDCDC; padding: 5px;" |
!'''[[Pleuritis]]'''
| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]] or [[chronic]]
| style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
| style="background: #F5F5F5; padding: 5px;" |
*Sharp
*Localized [[pleuritic]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Sharp [[chest pain]] with breathing
*[[Itching]] in sites on the back
*[[Dizziness]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Autoimmune]] conditions
* Infections
| style="background: #F5F5F5; padding: 5px;" |
* [[Tachypnea]]
* [[Tachycardia]] 
*[[Pleural friction rub|Pleural Rubs]]
*Decreased breath sounds
| style="background: #F5F5F5; padding: 5px;" |
*[[Leukocytosis]]
*[[Arterial blood gases|Arterial blood gas (ABG)]]: [[Hypoxia]]
*[[Thoracentesis|Thoracocentesis]]
| style="background: #F5F5F5; padding: 5px;" |
*[[EKG]] done to rule out other causes in differential diagnoses
| style="background: #F5F5F5; padding: 5px;" |
*[[Chest X Ray]]: [[Pleural fluid]] on one or both sides
*[[Computerized tomography]] (CT) scan: [[Pleural effusions]]
| style="background: #F5F5F5; padding: 5px;" |
*[[CXR]]
|- style="background: #DCDCDC; padding: 5px;" |
!'''[[Pulmonary Hypertension]]'''<ref name="pmid15006585">{{cite journal |vauthors=Mesquita SM, Castro CR, Ikari NM, Oliveira SA, Lopes AA |title=Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension |journal=Am. J. Med. |volume=116 |issue=6 |pages=369–74 |date=March 2004 |pmid=15006585 |doi=10.1016/j.amjmed.2003.11.015 |url=}}</ref><ref name="pmid11591592">{{cite journal |vauthors=Rich S, McLaughlin VV, O'Neill W |title=Stenting to reverse left ventricular ischemia due to left main coronary artery compression in primary pulmonary hypertension |journal=Chest |volume=120 |issue=4 |pages=1412–5 |date=October 2001 |pmid=11591592 |doi= |url=}}</ref><ref name="pmid10190427">{{cite journal |vauthors=Kawut SM, Silvestry FE, Ferrari VA, DeNofrio D, Axel L, Loh E, Palevsky HI |title=Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertension |journal=Am. J. Cardiol. |volume=83 |issue=6 |pages=984–6, A10 |date=March 1999 |pmid=10190427 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]] or [[chronic]]
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |
*[[Substernal]] pressure like
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Dyspnea]]
*Symptoms of [[right heart failure]] ([[edema]])
*Past history of [[heart murmur]]
*[[Deep venous thrombosis|Deep venous thrombosis (DVT)]]
*[[Arthritis]] or [[Arthralgia|arthralgias]]
*[[Rash]]
| style="background: #F5F5F5; padding: 5px;" |
* Smoking
* [[HF]]
* Heavy [[snoring]]
* [[Morbid obesity]]
| style="background: #F5F5F5; padding: 5px;" |
*The intensity of the [[P2|pulmonic component of the second heart sound (P2]]) may be increased and the [[P2]] may demonstrate fixed or paradoxical [[splitting]]. 
*[[Systolic ejection murmur]]
*A [[S4|right-sided fourth heart sound (S4)]] with a left [[parasternal heave]]
| style="background: #F5F5F5; padding: 5px;" |
*Abnormal [[Arterial blood gases|Arterial blood gas]]
*[[Antinuclear antibody|Antinuclear antibody (ANA) levels]]
*[[Anti-neutrophil cytoplasmic antibody|Antineutrophil cytoplasmic antibody (ANCA)]]
*[[Brain natriuretic peptide|Brain natriuretic peptide (BNP of NT-proBNP)]]
*[[HIV testing]]
*[[Iron deficiency]]
*[[PFTs|Pulmonary Function Testing]]
*[[Polysomnography]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Right axis deviation]]
*An R wave/S wave ratio greater than one in lead V1
*Incomplete or complete [[right bundle branch block]]
*Increased P wave amplitude in lead II (P pulmonale) due to right [[atrial enlargement]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Chest Radiography]]: [[Oligemic]] lung fields 
*[[Echocardiography]]:  [[PASP]] is >50 and the TRV is >3.4
*[[Ventilation-Perfusion (V/Q) Lung Scanning]]: Abnormal
*Right-sided [[cardiac catheterization]]: Mean [[PCWP]] >15 mmHg,
| style="background: #F5F5F5; padding: 5px;" |
*[[Cardiac catheterization]]
|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
![[Pleural Effusion]]<ref name="pmid3757561">{{cite journal |vauthors=Feinsilver SH, Barrows AA, Braman SS |title=Fiberoptic bronchoscopy and pleural effusion of unknown origin |journal=Chest |volume=90 |issue=4 |pages=516–9 |date=October 1986 |pmid=3757561 |doi= |url=}}</ref><ref name="pmid3581930">{{cite journal |vauthors=Collins TR, Sahn SA |title=Thoracocentesis. Clinical value, complications, technical problems, and patient experience |journal=Chest |volume=91 |issue=6 |pages=817–22 |date=June 1987 |pmid=3581930 |doi= |url=}}</ref><ref name="pmid15753638">{{cite journal |vauthors=Venekamp LN, Velkeniers B, Noppen M |title=Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy |journal=Respiration |volume=72 |issue=1 |pages=74–8 |date=2005 |pmid=15753638 |doi=10.1159/000083404 |url=}}</ref>
![[Pleural Effusion]]<ref name="pmid3757561">{{cite journal |vauthors=Feinsilver SH, Barrows AA, Braman SS |title=Fiberoptic bronchoscopy and pleural effusion of unknown origin |journal=Chest |volume=90 |issue=4 |pages=516–9 |date=October 1986 |pmid=3757561 |doi= |url=}}</ref><ref name="pmid3581930">{{cite journal |vauthors=Collins TR, Sahn SA |title=Thoracocentesis. Clinical value, complications, technical problems, and patient experience |journal=Chest |volume=91 |issue=6 |pages=817–22 |date=June 1987 |pmid=3581930 |doi= |url=}}</ref><ref name="pmid15753638">{{cite journal |vauthors=Venekamp LN, Velkeniers B, Noppen M |title=Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy |journal=Respiration |volume=72 |issue=1 |pages=74–8 |date=2005 |pmid=15753638 |doi=10.1159/000083404 |url=}}</ref>
Line 894: Line 733:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Computed tomography]]
*[[Computed tomography]]
|- style="background: #DCDCDC; padding: 5px;" |
![[Asthma]] & [[COPD]]<ref name="pmid19423717">{{cite journal |vauthors=Kuempel ED, Wheeler MW, Smith RJ, Vallyathan V, Green FH |title=Contributions of dust exposure and cigarette smoking to emphysema severity in coal miners in the United States |journal=Am. J. Respir. Crit. Care Med. |volume=180 |issue=3 |pages=257–64 |date=August 2009 |pmid=19423717 |doi=10.1164/rccm.200806-840OC |url=}}</ref><ref name="pmid20884729">{{cite journal |vauthors=Lamprecht B, McBurnie MA, Vollmer WM, Gudmundsson G, Welte T, Nizankowska-Mogilnicka E, Studnicka M, Bateman E, Anto JM, Burney P, Mannino DM, Buist SA |title=COPD in never smokers: results from the population-based burden of obstructive lung disease study |journal=Chest |volume=139 |issue=4 |pages=752–763 |date=April 2011 |pmid=20884729 |pmc=3168866 |doi=10.1378/chest.10-1253 |url=}}</ref><ref name="pmid12412667">{{cite journal |vauthors=Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J |title=Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey |journal=Eur. Respir. J. |volume=20 |issue=4 |pages=799–805 |date=October 2002 |pmid=12412667 |doi= |url=}}</ref><ref name="pmid8430714">{{cite journal |vauthors=Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL |title=Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone? |journal=Am. J. Med. |volume=94 |issue=2 |pages=188–96 |date=February 1993 |pmid=8430714 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]] or [[chronic]]
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |
*Tightness
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
*[[Cyanosis]]
| style="background: #F5F5F5; padding: 5px;" |
* Smoking
* [[HF]]
* [[HTN]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Elevated jugular venous pressure|Elevated jugular venous pulse (JVP]])
* [[Hyperinflation]] ([[barrel chest]])
* [[Peripheral edema]]
* [[Clubbing]]
*[[Wheezing]]
*[[Rhonchi]]
*Diffusely decreased [[breath sounds]]
*Coarse [[crackles]] beginning with [[inspiration]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Leukocytosis]]
*[[Eosinophilia]]
*[[Respiratory alkalosis]]
| style="background: #F5F5F5; padding: 5px;" |
*Peaked P-wave
*Reduced amplitude of the [[QRS complexes]]
*[[Multifocal atrial tachycardia]] (MAT)
| style="background: #F5F5F5; padding: 5px;" |
*[[CXR]]: [[Hyperinflation]]
*[[Spirometry]]: ↓ [[FEV1]], [[Peak expiratory flow|PEF]], ↓ [[FEV1]]/[[FVC]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Spirometry]]
|- style="background: #DCDCDC; padding: 5px;" |
![[Lung Cancer|Pulmonary Malignancy]]<ref name="pmid25564398">{{cite journal |vauthors=Kocher F, Hilbe W, Seeber A, Pircher A, Schmid T, Greil R, Auberger J, Nevinny-Stickel M, Sterlacci W, Tzankov A, Jamnig H, Kohler K, Zabernigg A, Frötscher J, Oberaigner W, Fiegl M |title=Longitudinal analysis of 2293 NSCLC patients: a comprehensive study from the TYROL registry |journal=Lung Cancer |volume=87 |issue=2 |pages=193–200 |date=February 2015 |pmid=25564398 |doi=10.1016/j.lungcan.2014.12.006 |url=}}</ref><ref name="pmid4813837">{{cite journal |vauthors=Hyde L, Hyde CI |title=Clinical manifestations of lung cancer |journal=Chest |volume=65 |issue=3 |pages=299–306 |date=March 1974 |pmid=4813837 |doi= |url=}}</ref><ref name="pmid2992757">{{cite journal |vauthors=Chute CG, Greenberg ER, Baron J, Korson R, Baker J, Yates J |title=Presenting conditions of 1539 population-based lung cancer patients by cell type and stage in New Hampshire and Vermont |journal=Cancer |volume=56 |issue=8 |pages=2107–11 |date=October 1985 |pmid=2992757 |doi= |url=}}</ref><ref name="pmid15165088">{{cite journal |vauthors=Hiraki A, Ueoka H, Takata I, Gemba K, Bessho A, Segawa Y, Kiura K, Eguchi K, Yoneda T, Tanimoto M, Harada M |title=Hypercalcemia-leukocytosis syndrome associated with lung cancer |journal=Lung Cancer |volume=43 |issue=3 |pages=301–7 |date=March 2004 |pmid=15165088 |doi=10.1016/j.lungcan.2003.09.006 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Chronic
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |
*Dull aching
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Bone pain]]
*[[Fatigue]]
*[[Neurologic dysfunction]]
*[[Superior vena cava syndrome|Superior vena cava (SVC) obstruction]]
*[[Hoarseness]]
*Hemidiaphragm [[paralysis]]
*[[Dysphagia]]
*[[Paraneoplastic syndrome|Paraneoplastic syndromes]]
*[[Hypercalcemia]]
| style="background: #F5F5F5; padding: 5px;" |
* Smoking
* [[Metastasis]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Wheeze]]
*[[Crackles]]
*Depending upon [[complications]] caused by the spread of [[cancer]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Hypercalcemia]]
| style="background: #F5F5F5; padding: 5px;" |
*[[EKG]] may be performed before cancer treatment to identify any pre-existing conditions, or during treatment to check for possible heart damage
| style="background: #F5F5F5; padding: 5px;" |
*[[CXR]] and [[CT scan]]: Mass lesion, [[hilar lymphadenopathy]]
*[[Spirometry]]: ↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
*[[Bronchoscopy]]: [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Bronchoscopy]] 
|- style="background: #DCDCDC; padding: 5px;" |
![[Sarcoidosis]]<ref name="pmid26727158">{{cite journal |vauthors=Ungprasert P, Carmona EM, Utz JP, Ryu JH, Crowson CS, Matteson EL |title=Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study |journal=Mayo Clin. Proc. |volume=91 |issue=2 |pages=183–8 |date=February 2016 |pmid=26727158 |pmc=4744129 |doi=10.1016/j.mayocp.2015.10.024 |url=}}</ref><ref name="pmid11734441">{{cite journal |vauthors=Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R |title=Clinical characteristics of patients in a case control study of sarcoidosis |journal=Am. J. Respir. Crit. Care Med. |volume=164 |issue=10 Pt 1 |pages=1885–9 |date=November 2001 |pmid=11734441 |doi=10.1164/ajrccm.164.10.2104046 |url=}}</ref><ref name="pmid15753626">{{cite journal |vauthors=Rizzato G, Tinelli C |title=Unusual presentation of sarcoidosis |journal=Respiration |volume=72 |issue=1 |pages=3–6 |date=2005 |pmid=15753626 |doi=10.1159/000083392 |url=}}</ref><ref name="pmid15281433">{{cite journal |vauthors=Rizzato G, Palmieri G, Agrati AM, Zanussi C |title=The organ-specific extrapulmonary presentation of sarcoidosis: a frequent occurrence but a challenge to an early diagnosis. A 3-year-long prospective observational study |journal=Sarcoidosis Vasc Diffuse Lung Dis |volume=21 |issue=2 |pages=119–26 |date=June 2004 |pmid=15281433 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Chronic
| style="background: #F5F5F5; padding: 5px;" |Days to week
| style="background: #F5F5F5; padding: 5px;" |
*Chest fullness
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Löfgren syndrome]] ([[fever]], bilateral hilar [[lymphadenopathy]] (BHL), and [[Polyarthralgia|polyarthralgias]])
*[[Uveitis]]
*[[Heart block]]
*[[Lymphocytic]] [[meningitis]]
*[[Diabetes insipidus]]
*[[Fatigue]]
*[[Hypercalciuria]]
| style="background: #F5F5F5; padding: 5px;" |
* Black population
* [[Autoimmune]] diseases
| style="background: #F5F5F5; padding: 5px;" |
*Diminished respiratory sounds
| style="background: #F5F5F5; padding: 5px;" |
*↑ [[ACE level]], [[adenosine deaminase]], SAA, sIL2R
*[[Hypercalciuria]]
*Elevated [[1,25-dihydroxyvitamin D]] levels
| style="background: #F5F5F5; padding: 5px;" |
*[[AV block]]
*Prolongation of the [[PR interval]] (first-degree AV block)
*[[Ventricular arrhythmias]] (sustained or nonsustained [[ventricular tachycardia]] and ventricular premature beats [VPBs]) 
*[[Supraventricular arrhythmias]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Chest radiograph]]: [[Bilateral hilar adenopathy]]
*High-resolution CT (HRCT) scanning of the chest: [[Ground glass]] opacification, Hilar and [[mediastinal lymphadenopathy]],    [[Bronchial]] wall thickening
| style="background: #F5F5F5; padding: 5px;" |
*Lung [[Biopsy]]
|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
![[Acute chest syndrome]] ([[Sickle cell anemia|Sickle cell anemia)]]<ref name="pmid9057664">{{cite journal |vauthors=Vichinsky EP, Styles LA, Colangelo LH, Wright EC, Castro O, Nickerson B |title=Acute chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Cell Disease |journal=Blood |volume=89 |issue=5 |pages=1787–92 |date=March 1997 |pmid=9057664 |doi= |url=}}</ref><ref name="pmid7517723">{{cite journal |vauthors=Castro O, Brambilla DJ, Thorington B, Reindorf CA, Scott RB, Gillette P, Vera JC, Levy PS |title=The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease |journal=Blood |volume=84 |issue=2 |pages=643–9 |date=July 1994 |pmid=7517723 |doi= |url=}}</ref><ref name="pmid10861320">{{cite journal |vauthors=Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, Nickerson B, Orringer E, McKie V, Bellevue R, Daeschner C, Manci EA |title=Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group |journal=N. Engl. J. Med. |volume=342 |issue=25 |pages=1855–65 |date=June 2000 |pmid=10861320 |doi=10.1056/NEJM200006223422502 |url=}}</ref>
![[Acute chest syndrome]] ([[Sickle cell anemia|Sickle cell anemia)]]<ref name="pmid9057664">{{cite journal |vauthors=Vichinsky EP, Styles LA, Colangelo LH, Wright EC, Castro O, Nickerson B |title=Acute chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Cell Disease |journal=Blood |volume=89 |issue=5 |pages=1787–92 |date=March 1997 |pmid=9057664 |doi= |url=}}</ref><ref name="pmid7517723">{{cite journal |vauthors=Castro O, Brambilla DJ, Thorington B, Reindorf CA, Scott RB, Gillette P, Vera JC, Levy PS |title=The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease |journal=Blood |volume=84 |issue=2 |pages=643–9 |date=July 1994 |pmid=7517723 |doi= |url=}}</ref><ref name="pmid10861320">{{cite journal |vauthors=Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, Nickerson B, Orringer E, McKie V, Bellevue R, Daeschner C, Manci EA |title=Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group |journal=N. Engl. J. Med. |volume=342 |issue=25 |pages=1855–65 |date=June 2000 |pmid=10861320 |doi=10.1056/NEJM200006223422502 |url=}}</ref>
Line 1,061: Line 788:
|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
| rowspan="9" |Gastrointestinal  
| rowspan="9" |Gastrointestinal  
!'''[[GERD]], [[Peptic Ulcer]]'''<ref name="pmid16928254">{{cite journal |vauthors=Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R |title=The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus |journal=Am. J. Gastroenterol. |volume=101 |issue=8 |pages=1900–20; quiz 1943 |date=August 2006 |pmid=16928254 |doi=10.1111/j.1572-0241.2006.00630.x |url=}}</ref><ref name="pmid15290658">{{cite journal |vauthors=Vakil NB, Traxler B, Levine D |title=Dysphagia in patients with erosive esophagitis: prevalence, severity, and response to proton pump inhibitor treatment |journal=Clin. Gastroenterol. Hepatol. |volume=2 |issue=8 |pages=665–8 |date=August 2004 |pmid=15290658 |doi= |url=}}</ref><ref name="pmid18289194">{{cite journal |vauthors=Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V |title=Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment |journal=Am. J. Gastroenterol. |volume=103 |issue=2 |pages=267–75 |date=February 2008 |pmid=18289194 |doi=10.1111/j.1572-0241.2007.01659.x |url=}}</ref>
!'''Perforated [[Peptic Ulcer]]'''<ref name="pmid16928254">{{cite journal |vauthors=Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R |title=The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus |journal=Am. J. Gastroenterol. |volume=101 |issue=8 |pages=1900–20; quiz 1943 |date=August 2006 |pmid=16928254 |doi=10.1111/j.1572-0241.2006.00630.x |url=}}</ref><ref name="pmid15290658">{{cite journal |vauthors=Vakil NB, Traxler B, Levine D |title=Dysphagia in patients with erosive esophagitis: prevalence, severity, and response to proton pump inhibitor treatment |journal=Clin. Gastroenterol. Hepatol. |volume=2 |issue=8 |pages=665–8 |date=August 2004 |pmid=15290658 |doi= |url=}}</ref><ref name="pmid18289194">{{cite journal |vauthors=Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V |title=Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment |journal=Am. J. Gastroenterol. |volume=103 |issue=2 |pages=267–75 |date=February 2008 |pmid=18289194 |doi=10.1111/j.1572-0241.2007.01659.x |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,100: Line 827:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*Upper [[Gastrointestinal]] [[Endoscopy]]
*Upper [[Gastrointestinal]] [[Endoscopy]]
|- style="background: #DCDCDC; padding: 5px;" |
!'''[[Diffuse Esophageal Spasm]]'''<ref name="pmid3826958">{{cite journal |vauthors=Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO |title=Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years' experience with 1161 patients |journal=Ann. Intern. Med. |volume=106 |issue=4 |pages=593–7 |date=April 1987 |pmid=3826958 |doi= |url=}}</ref><ref name="pmid20179690">{{cite journal |vauthors=Kahrilas PJ |title=Esophageal motor disorders in terms of high-resolution esophageal pressure topography: what has changed? |journal=Am. J. Gastroenterol. |volume=105 |issue=5 |pages=981–7 |date=May 2010 |pmid=20179690 |pmc=2888528 |doi=10.1038/ajg.2010.43 |url=}}</ref><ref name="pmid17900331">{{cite journal |vauthors=Pandolfino JE, Ghosh SK, Rice J, Clarke JO, Kwiatek MA, Kahrilas PJ |title=Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls |journal=Am. J. Gastroenterol. |volume=103 |issue=1 |pages=27–37 |date=January 2008 |pmid=17900331 |doi=10.1111/j.1572-0241.2007.01532.x |url=}}</ref><ref name="pmid18364587">{{cite journal |vauthors=Kahrilas PJ, Ghosh SK, Pandolfino JE |title=Esophageal motility disorders in terms of pressure topography: the Chicago Classification |journal=J. Clin. Gastroenterol. |volume=42 |issue=5 |pages=627–35 |date=2008 |pmid=18364587 |pmc=2895002 |doi=10.1097/MCG.0b013e31815ea291 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
| style="background: #F5F5F5; padding: 5px;" |
*Minutes to hours
*5 to 60 minutes
| style="background: #F5F5F5; padding: 5px;" |
*Burning
*Pressure
*[[Visceral]], spontaneous, [[substernal]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
*Associated with cold liquids
*Relief with [[nitroglycerin]]
| style="background: #F5F5F5; padding: 5px;" | ---
| style="background: #F5F5F5; padding: 5px;" | ---
| style="background: #F5F5F5; padding: 5px;" |
*[[Barium swallow]]: Multiple areas of [[spasm]]  throughout the length of the esophagus
*Impedance testing: Higher amplitudes and better transit of swallowed boluses
| style="background: #F5F5F5; padding: 5px;" |
*No ECG findings associated with DES, but ECG is done to exclude [[variant angina]] due to higher concurrent association of variant angina with DES 
| style="background: #F5F5F5; padding: 5px;" |
*Esophageal [[Esophageal motility study|manometry]] : ≥20 percent premature contractions (distal latency <4.5 seconds)
| style="background: #F5F5F5; padding: 5px;" |
* [[Esophageal manometry]]
|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
![[Esophagitis]]<ref name="pmid3605035">{{cite journal |vauthors=Bott S, Prakash C, McCallum RW |title=Medication-induced esophageal injury: survey of the literature |journal=Am. J. Gastroenterol. |volume=82 |issue=8 |pages=758–63 |date=August 1987 |pmid=3605035 |doi= |url=}}</ref><ref name="pmid18763324">{{cite journal |vauthors=Parfitt JR, Jayakumar S, Driman DK |title=Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes |journal=Am. J. Surg. Pathol. |volume=32 |issue=9 |pages=1367–72 |date=September 2008 |pmid=18763324 |doi= |url=}}</ref><ref name="pmid10738847">{{cite journal |vauthors=Jaspersen D |title=Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and management |journal=Drug Saf |volume=22 |issue=3 |pages=237–49 |date=March 2000 |pmid=10738847 |doi= |url=}}</ref>
![[Esophagitis]]<ref name="pmid3605035">{{cite journal |vauthors=Bott S, Prakash C, McCallum RW |title=Medication-induced esophageal injury: survey of the literature |journal=Am. J. Gastroenterol. |volume=82 |issue=8 |pages=758–63 |date=August 1987 |pmid=3605035 |doi= |url=}}</ref><ref name="pmid18763324">{{cite journal |vauthors=Parfitt JR, Jayakumar S, Driman DK |title=Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes |journal=Am. J. Surg. Pathol. |volume=32 |issue=9 |pages=1367–72 |date=September 2008 |pmid=18763324 |doi= |url=}}</ref><ref name="pmid10738847">{{cite journal |vauthors=Jaspersen D |title=Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and management |journal=Drug Saf |volume=22 |issue=3 |pages=237–49 |date=March 2000 |pmid=10738847 |doi= |url=}}</ref>
Line 1,159: Line 858:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Endoscopy]]
*[[Endoscopy]]
|- style="background: #DCDCDC; padding: 5px;" |
![[Eosinophilic esophagitis|Eosinophilic Esophagitis]]<ref name="pmid18471509">{{cite journal |vauthors=Kapel RC, Miller JK, Torres C, Aksoy S, Lash R, Katzka DA |title=Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups |journal=Gastroenterology |volume=134 |issue=5 |pages=1316–21 |date=May 2008 |pmid=18471509 |doi=10.1053/j.gastro.2008.02.016 |url=}}</ref><ref name="pmid12612531">{{cite journal |vauthors=Straumann A, Rossi L, Simon HU, Heer P, Spichtin HP, Beglinger C |title=Fragility of the esophageal mucosa: a pathognomonic endoscopic sign of primary eosinophilic esophagitis? |journal=Gastrointest. Endosc. |volume=57 |issue=3 |pages=407–12 |date=March 2003 |pmid=12612531 |doi=10.1067/mge.2003.123 |url=}}</ref><ref name="pmid18407800">{{cite journal |vauthors=Straumann A, Bussmann C, Zuber M, Vannini S, Simon HU, Schoepfer A |title=Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients |journal=Clin. Gastroenterol. Hepatol. |volume=6 |issue=5 |pages=598–600 |date=May 2008 |pmid=18407800 |doi=10.1016/j.cgh.2008.02.003 |url=}}</ref><ref name="pmid19577011">{{cite journal |vauthors=Prasad GA, Alexander JA, Schleck CD, Zinsmeister AR, Smyrk TC, Elias RM, Locke GR, Talley NJ |title=Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=10 |pages=1055–61 |date=October 2009 |pmid=19577011 |pmc=3026355 |doi=10.1016/j.cgh.2009.06.023 |url=}}</ref><ref name="pmid17764492">{{cite journal |vauthors=Prasad GA, Talley NJ, Romero Y, Arora AS, Kryzer LA, Smyrk TC, Alexander JA |title=Prevalence and predictive factors of eosinophilic esophagitis in patients presenting with dysphagia: a prospective study |journal=Am. J. Gastroenterol. |volume=102 |issue=12 |pages=2627–32 |date=December 2007 |pmid=17764492 |doi=10.1111/j.1572-0241.2007.01512.x |url=}}</ref><ref name="pmid15933677">{{cite journal |vauthors=Desai TK, Stecevic V, Chang CH, Goldstein NS, Badizadegan K, Furuta GT |title=Association of eosinophilic inflammation with esophageal food impaction in adults |journal=Gastrointest. Endosc. |volume=61 |issue=7 |pages=795–801 |date=June 2005 |pmid=15933677 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |
*Burning
*[[Retrosternal]]
*Abdominal
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Dysphagia]]
* Food impaction
* [[GERD]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Allergy|Allergic]] [[Disease|diseases]]
*[[Asthma]]
*[[Rinitis]]
*[[Eczema]]
| style="background: #F5F5F5; padding: 5px;" |
*No auscultatory finding in the this [[disease]]
| style="background: #F5F5F5; padding: 5px;" |
*Elevated [[IgE]] (>114,000 units/L)
*Elevated peripheral [[eosinophils]]
| style="background: #F5F5F5; padding: 5px;" |
*Typically no finding on EKG
| style="background: #F5F5F5; padding: 5px;" |
*[[Barium studies]]: [[Strictures]] and a ringed esophagus
*[[Endoscopy]]: Stacked circular rings ("feline" esophagus)  ●[[Strictures]]  ●Linear furrows  ●Whitish papules 
*[[Esophageal biopsy]]: More than 15 [[Eosinophil granulocyte|eosinophils]] per high-power field
| style="background: #F5F5F5; padding: 5px;" |
*Esophageal [[biopsy]]
|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
![[Esophageal perforation|Esophageal Perforation]]<ref name="pmid2730190">{{cite journal |vauthors=Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH |title=Spontaneous rupture of the esophagus: a 30-year experience |journal=Ann. Thorac. Surg. |volume=47 |issue=5 |pages=689–92 |date=May 1989 |pmid=2730190 |doi= |url=}}</ref>
![[Esophageal perforation|Esophageal Perforation]]<ref name="pmid2730190">{{cite journal |vauthors=Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH |title=Spontaneous rupture of the esophagus: a 30-year experience |journal=Ann. Thorac. Surg. |volume=47 |issue=5 |pages=689–92 |date=May 1989 |pmid=2730190 |doi= |url=}}</ref>
Line 1,262: Line 927:
| style="background: #F5F5F5; padding: 5px;" | CT scan
| style="background: #F5F5F5; padding: 5px;" | CT scan
|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
!'''[[Gallstone disease| Cholelithiasis]]'''<ref name="pmid19190960">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |date=April 2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref><ref name="pmid18000708">{{cite journal |vauthors=Yang MH, Chen TH, Wang SE, Tsai YF, Su CH, Wu CW, Lui WY, Shyr YM |title=Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy |journal=Surg Endosc |volume=22 |issue=7 |pages=1620–4 |date=July 2008 |pmid=18000708 |doi=10.1007/s00464-007-9665-2 |url=}}</ref><ref name="pmid10077048">{{cite journal |vauthors=Prat F, Meduri B, Ducot B, Chiche R, Salimbeni-Bartolini R, Pelletier G |title=Prediction of common bile duct stones by noninvasive tests |journal=Ann. Surg. |volume=229 |issue=3 |pages=362–8 |date=March 1999 |pmid=10077048 |pmc=1191701 |doi= |url=}}</ref><ref name="pmid15332044">{{cite journal |vauthors=Tse F, Barkun JS, Barkun AN |title=The elective evaluation of patients with suspected choledocholithiasis undergoing laparoscopic cholecystectomy |journal=Gastrointest. Endosc. |volume=60 |issue=3 |pages=437–48 |date=September 2004 |pmid=15332044 |doi= |url=}}</ref>
 
| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]], [[subacute]]
| style="background: #F5F5F5; padding: 5px;" |Minutes to hours
| style="background: #F5F5F5; padding: 5px;" |
*Burning
*Colicky
*Right upper [[abdomen]]
*Substernal
*[[epigastric]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Obesity]]
*Fertile females in 40's
| style="background: #F5F5F5; padding: 5px;" |
*The presence of a common bile duct stone on transabdominal ultrasound
•Clinical acute cholangitis
•A serum bilirubin greater than 4 mg/dL (68 micromol/L)
| style="background: #F5F5F5; padding: 5px;" |
*Murphy sign negative
*Jaundice
| style="background: #F5F5F5; padding: 5px;" |
*↑ALT
*↑AST
*↑[[Amylase]] levels
*↑ALP
| style="background: #F5F5F5; padding: 5px;" |
*Typically not indicated
| style="background: #F5F5F5; padding: 5px;" |
*Transabdominal [[ultrasound]] (TAUS): shows gallstones
*EUS: Detects biliary sludge
*MRCP: Detects stones >6mm
*Endoscopic Retrograde Cholangiopancreatography (ERCP): Diagnostic and therapeutic removal of stones
|Endoscopic ultrasound and MECP
|- style="background: #DCDCDC; padding: 5px;" |
![[Pancreatitis]]<ref name="pmid6237447">{{cite journal |vauthors=Dickson AP, Imrie CW |title=The incidence and prognosis of body wall ecchymosis in acute pancreatitis |journal=Surg Gynecol Obstet |volume=159 |issue=4 |pages=343–7 |date=October 1984 |pmid=6237447 |doi= |url=}}</ref><ref name="pmid12094843">{{cite journal |vauthors=Yadav D, Agarwal N, Pitchumoni CS |title=A critical evaluation of laboratory tests in acute pancreatitis |journal=Am. J. Gastroenterol. |volume=97 |issue=6 |pages=1309–18 |date=June 2002 |pmid=12094843 |doi=10.1111/j.1572-0241.2002.05766.x |url=}}</ref><ref name="pmid8540502">{{cite journal |vauthors=Fortson MR, Freedman SN, Webster PD |title=Clinical assessment of hyperlipidemic pancreatitis |journal=Am. J. Gastroenterol. |volume=90 |issue=12 |pages=2134–9 |date=December 1995 |pmid=8540502 |doi= |url=}}</ref><ref name="pmid10352598">{{cite journal |vauthors=Lecesne R, Taourel P, Bret PM, Atri M, Reinhold C |title=Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome |journal=Radiology |volume=211 |issue=3 |pages=727–35 |date=June 1999 |pmid=10352598 |doi=10.1148/radiology.211.3.r99jn08727 |url=}}</ref><ref name="pmid17378903">{{cite journal |vauthors=Stimac D, Miletić D, Radić M, Krznarić I, Mazur-Grbac M, Perković D, Milić S, Golubović V |title=The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis |journal=Am. J. Gastroenterol. |volume=102 |issue=5 |pages=997–1004 |date=May 2007 |pmid=17378903 |doi=10.1111/j.1572-0241.2007.01164.x |url=}}</ref>
![[Pancreatitis]]<ref name="pmid6237447">{{cite journal |vauthors=Dickson AP, Imrie CW |title=The incidence and prognosis of body wall ecchymosis in acute pancreatitis |journal=Surg Gynecol Obstet |volume=159 |issue=4 |pages=343–7 |date=October 1984 |pmid=6237447 |doi= |url=}}</ref><ref name="pmid12094843">{{cite journal |vauthors=Yadav D, Agarwal N, Pitchumoni CS |title=A critical evaluation of laboratory tests in acute pancreatitis |journal=Am. J. Gastroenterol. |volume=97 |issue=6 |pages=1309–18 |date=June 2002 |pmid=12094843 |doi=10.1111/j.1572-0241.2002.05766.x |url=}}</ref><ref name="pmid8540502">{{cite journal |vauthors=Fortson MR, Freedman SN, Webster PD |title=Clinical assessment of hyperlipidemic pancreatitis |journal=Am. J. Gastroenterol. |volume=90 |issue=12 |pages=2134–9 |date=December 1995 |pmid=8540502 |doi= |url=}}</ref><ref name="pmid10352598">{{cite journal |vauthors=Lecesne R, Taourel P, Bret PM, Atri M, Reinhold C |title=Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome |journal=Radiology |volume=211 |issue=3 |pages=727–35 |date=June 1999 |pmid=10352598 |doi=10.1148/radiology.211.3.r99jn08727 |url=}}</ref><ref name="pmid17378903">{{cite journal |vauthors=Stimac D, Miletić D, Radić M, Krznarić I, Mazur-Grbac M, Perković D, Milić S, Golubović V |title=The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis |journal=Am. J. Gastroenterol. |volume=102 |issue=5 |pages=997–1004 |date=May 2007 |pmid=17378903 |doi=10.1111/j.1572-0241.2007.01164.x |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]], [[Chronic (medical)|Chronic]]
| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]], [[Chronic (medical)|Chronic]]
Line 1,342: Line 971:
*CT Scan
*CT Scan
|- style="background: #DCDCDC; padding: 5px;" |
|- style="background: #DCDCDC; padding: 5px;" |
![[Hiatal Hernia|Sliding Hiatal Hernia]]<ref name="pmid8899401">{{cite journal |vauthors=Weston AP |title=Hiatal hernia with cameron ulcers and erosions |journal=Gastrointest. Endosc. Clin. N. Am. |volume=6 |issue=4 |pages=671–9 |date=October 1996 |pmid=8899401 |doi= |url=}}</ref><ref name="pmid16472589">{{cite journal |vauthors=Bredenoord AJ, Weusten BL, Timmer R, Smout AJ |title=Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux |journal=Gastroenterology |volume=130 |issue=2 |pages=334–40 |date=February 2006 |pmid=16472589 |doi=10.1053/j.gastro.2005.10.053 |url=}}</ref><ref name="pmid18656819">{{cite journal |vauthors=Kahrilas PJ, Kim HC, Pandolfino JE |title=Approaches to the diagnosis and grading of hiatal hernia |journal=Best Pract Res Clin Gastroenterol |volume=22 |issue=4 |pages=601–16 |date=2008 |pmid=18656819 |pmc=2548324 |doi=10.1016/j.bpg.2007.12.007 |url=}}</ref>
![[IBD]]<ref name="ColbertSchmidt2017">{{cite journal|last1=Colbert|first1=James F.|last2=Schmidt|first2=Eric P.|last3=Faubel|first3=Sarah|last4=Ginde|first4=Adit A.|title=Severe Sepsis Outcomes Among Hospitalizations With Inflammatory Bowel Disease|journal=SHOCK|volume=47|issue=2|year=2017|pages=128–131|issn=1073-2322|doi=10.1097/SHK.0000000000000742}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]], [[Chronic (medical)|Chronic]]
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |
*[[Epigastric]]
*Burning
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Obstruction]]
*Cameron [[Ulcer|ulcers]]
*GERD
*Dysphagia
| style="background: #F5F5F5; padding: 5px;" |
* Trauma
* Iatrogenic
* Congenital malformation
| style="background: #F5F5F5; padding: 5px;" |
*Bowel sounds may be heard in the chest
| style="background: #F5F5F5; padding: 5px;" |
*Non specific
| style="background: #F5F5F5; padding: 5px;" |
*T wave inversion in anterior lead.
| style="background: #F5F5F5; padding: 5px;" |
*Barium swallow: At least three rugal folds traversing the diaphragm 
*Upper endoscopy: A greater than 2-cm separation between the squamocolumnar junction and the diaphragmatic impression
*High resolution manometry: The separation of the crural diaphragm from the lower esophageal sphincter (LES) by a pressure trough
| style="background: #F5F5F5; padding: 5px;" |
*Upper endoscopy
*High resolution manometry (for smaller hernias)
|- style="background: #DCDCDC; padding: 5px;" |
| rowspan="6" |Musculoskeletal
![[Costochondritis|Costosternal syndromes (costochondritis)]]<ref name="pmid1247350">{{cite journal |vauthors=Wolf E, Stern S |title=Costosternal syndrome: its frequency and importance in differential diagnosis of coronary heart disease |journal=Arch. Intern. Med. |volume=136 |issue=2 |pages=189–91 |date=February 1976 |pmid=1247350 |doi= |url=}}</ref><ref name="pmid4027804">{{cite journal |vauthors=Fam AG, Smythe HA |title=Musculoskeletal chest wall pain |journal=CMAJ |volume=133 |issue=5 |pages=379–89 |date=September 1985 |pmid=4027804 |pmc=1346531 |doi= |url=}}</ref><ref name="pmid20406787">{{cite journal |vauthors=Bösner S, Becker A, Hani MA, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Haasenritter J, Baum E, Donner-Banzhoff N |title=Chest wall syndrome in primary care patients with chest pain: presentation, associated features and diagnosis |journal=Fam Pract |volume=27 |issue=4 |pages=363–9 |date=August 2010 |pmid=20406787 |doi=10.1093/fampra/cmq024 |url=}}</ref><ref name="pmid28593100">{{cite journal |vauthors=Zaruba RA, Wilson E |title=IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES |journal=Int J Sports Phys Ther |volume=12 |issue=3 |pages=458–467 |date=June 2017 |pmid=28593100 |pmc=5455195 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Acute, subacute
| style="background: #F5F5F5; padding: 5px;" |Days to weeks
| style="background: #F5F5F5; padding: 5px;" |
*Pressure like on anterior part of chest wall
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*History of repeated minor trauma or unaccustomed activity (eg, painting, moving furniture) 
| style="background: #F5F5F5; padding: 5px;" |
* Trauma
| style="background: #F5F5F5; padding: 5px;" |
*Pain by palpation of tender areas
*Maneuvers, such as the "crowing rooster" and horizontal arm flexion maneuver
| style="background: #F5F5F5; padding: 5px;" |
*Non specific
| style="background: #F5F5F5; padding: 5px;" |
*EKG is done to rule out other cardiovascular causes
| style="background: #F5F5F5; padding: 5px;" |
*CXR: To rule out fracture
|Pain by palpation of tender areas
|- style="background: #DCDCDC; padding: 5px;" |
!Lower rib pain syndromes<ref name="pmid8344569">{{cite journal |vauthors=Scott EM, Scott BB |title=Painful rib syndrome--a review of 76 cases |journal=Gut |volume=34 |issue=7 |pages=1006–8 |date=July 1993 |pmid=8344569 |pmc=1374244 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Chronic
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |
*Aching
*Lower chest
*Upper abdomen
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Common in women with a mean age in the mid-40s
| style="background: #F5F5F5; padding: 5px;" | ---
| style="background: #F5F5F5; padding: 5px;" |
*Hooking maneuver
*Reproduces pain by pressing a tender spot on the costal margin
| style="background: #F5F5F5; padding: 5px;" |
*Non specific
*The workup is done for excluding cardiac disorders and other causes of chest pain
| style="background: #F5F5F5; padding: 5px;" |
*EKG is done to rule out other cardiovascular causes
| style="background: #F5F5F5; padding: 5px;" |
*CXR: To rule out fracture
| style="background: #F5F5F5; padding: 5px;" | ---
|- style="background: #DCDCDC; padding: 5px;" |
!Sternalis syndrome
| style="background: #F5F5F5; padding: 5px;" |Chronic
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |Pressure like pain
*Over the body of sternum
*Sternalis muscle
*Left or middle side of the chest wall
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Heart|Cardiac]] diseases
| style="background: #F5F5F5; padding: 5px;" |
* Daily activities
* Emotional [[distress]]
* [[Anxiety]]
| style="background: #F5F5F5; padding: 5px;" |
*Localized [[tenderness]] is found directly over the body of the sternum or overlying sternalis muscle
| style="background: #F5F5F5; padding: 5px;" |
*No specific diagnostic test for this disease
*The workup is done for excluding cardiac disorders and other causes of chest pain
| style="background: #F5F5F5; padding: 5px;" |
*EKG is done to rule out other cardiovascular causes
| style="background: #F5F5F5; padding: 5px;" |
*[[X-rays|X-ray]] : To rule out fracture
| style="background: #F5F5F5; padding: 5px;" |
*Physical exam
|- style="background: #DCDCDC; padding: 5px;" |
![[Tietze's syndrome]]<ref name="pmid1697801">{{cite journal |vauthors=Aeschlimann A, Kahn MF |title=Tietze's syndrome: a critical review |journal=Clin. Exp. Rheumatol. |volume=8 |issue=4 |pages=407–12 |date=1990 |pmid=1697801 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Weeks
| style="background: #F5F5F5; padding: 5px;" |Pressure like pain over
*Costosternal joint
*[[Sternoclavicular articulation|Sternoclavicular]] joint
*[[Costochondral joint|Costochondral]] joint
*Second and third ribs
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Most often involve the areas of 2nd and 3rd ribs
*More common in young adults
*Sternocostoclavicular hyperostosis
*Ankylosing spondylitis
| style="background: #F5F5F5; padding: 5px;" |
* Upper respiratory infections
* Excessive coughing
| style="background: #F5F5F5; padding: 5px;" |
*Painful and localized swelling of the costosternal, [[Sternoclavicular articulation|sternoclavicular]], or [[Costochondral joint|costochondral joints]] most often involving 2nd and 3rd [[ribs]]
| style="background: #F5F5F5; padding: 5px;" |
*No specific diagnostic test for this disease
*The workup is done for excluding cardiac disorders and other causes of chest pain
| style="background: #F5F5F5; padding: 5px;" |
*EKG is done to rule out other cardiovascular causes
| style="background: #F5F5F5; padding: 5px;" |
*[[X-rays|X-ray]]: To rule out fracture
| style="background: #F5F5F5; padding: 5px;" |
*Tests are done to rule out other diseases
|- style="background: #DCDCDC; padding: 5px;" |
![[Xiphoidalgia]]<ref name="pmid13266001">{{cite journal |vauthors=LIPKIN M, FULTON LA, WOLFSON EA |title=The syndrome of the hypersensitive xiphoid |journal=N. Engl. J. Med. |volume=253 |issue=14 |pages=591–7 |date=October 1955 |pmid=13266001 |doi=10.1056/NEJM195510062531403 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |Pressure like pain over
*Over the xiphoid process
*Sternum
*Xiphisternal joint
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Symptoms are aggravated by twisting and bending movements
| style="background: #F5F5F5; padding: 5px;" |
* Cough
* Heavy work
| style="background: #F5F5F5; padding: 5px;" |
*Provocative test
| style="background: #F5F5F5; padding: 5px;" |
*No specific diagnostic test for this disease
*The workup is done for excluding cardiac disorders and other causes of chest pain
| style="background: #F5F5F5; padding: 5px;" |
*EKG is done to rule out other cardiovascular causes
| style="background: #F5F5F5; padding: 5px;" |
*X-ray: To rule out fracture
| style="background: #F5F5F5; padding: 5px;" |
*Tests are done to rule out other diseases
|- style="background: #DCDCDC; padding: 5px;" |
!Spontaneous [[sternoclavicular]] [[subluxation]]<ref name="pmid1458785">{{cite journal |vauthors=van Holsbeeck M, van Melkebeke J, Dequeker J, Pennes DR |title=Radiographic findings of spontaneous subluxation of the sternoclavicular joint |journal=Clin. Rheumatol. |volume=11 |issue=3 |pages=376–81 |date=September 1992 |pmid=1458785 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Acute, Chronic
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |Aching pain over [[Sternoclavicular articulation|Sternoclavicular joint]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*More common in middle age [[women]]
*Occurs in dominant hands with repetitive tasks of heavy or moderate quality
| style="background: #F5F5F5; padding: 5px;" |
* Trauma
| style="background: #F5F5F5; padding: 5px;" |
*[[Palpation]] of tender areas
| style="background: #F5F5F5; padding: 5px;" |
*No specific diagnostic test for this disease
*The workup is done for excluding cardiac disorders and other causes of chest pain
| style="background: #F5F5F5; padding: 5px;" |
*EKG is done to rule out other cardiovascular causes
| style="background: #F5F5F5; padding: 5px;" |
*[[X-rays|X-ray]]: Sclerosis of the medial clavicle 
| style="background: #F5F5F5; padding: 5px;" |
*X-ray
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="3" |Differentials on the basis of Etiology
! rowspan="3" |Disease
! colspan="10" |Clinical manifestations
! colspan="4" |Diagnosis
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| colspan="8" |Symptoms
| rowspan="2" |Risk factors
! rowspan="2" |Physical exam
! rowspan="2" |Lab workup
! rowspan="2" |EKG
! rowspan="2" |Imaging
! rowspan="2" |Gold standard
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Onset
!Duration
!Quality of Pain
!Cough
!Fever
!Dyspnea
!Weight loss
!Associated Features
|- style="background: #DCDCDC; padding: 5px;" |
| rowspan="7" |Rheumatic
![[Fibromyalgia]]<ref name="pmid20380956">{{cite journal |vauthors=Almansa C, Wang B, Achem SR |title=Noncardiac chest pain and fibromyalgia |journal=Med. Clin. North Am. |volume=94 |issue=2 |pages=275–89 |date=March 2010 |pmid=20380956 |doi=10.1016/j.mcna.2010.01.002 |url=}}</ref><ref name="pmid7979843">{{cite journal |vauthors=Disla E, Rhim HR, Reddy A, Karten I, Taranta A |title=Costochondritis. A prospective analysis in an emergency department setting |journal=Arch. Intern. Med. |volume=154 |issue=21 |pages=2466–9 |date=November 1994 |pmid=7979843 |doi= |url=}}</ref><ref name="pmid1543409">{{cite journal |vauthors=Wise CM, Semble EL, Dalton CB |title=Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients |journal=Arch Phys Med Rehabil |volume=73 |issue=2 |pages=147–9 |date=February 1992 |pmid=1543409 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*Raynaud phenomenon (RP)
*Painful bowl movments
*Deep [[Pain|ache]] and burning pain on
*Bloody diarrhea
**[[Shoulder|Shoulders]]
*pus or mucus in the stool
**Back of the [[Neck]]
*Fistula
**[[Chest]]
*sepsis
**Lower [[Human back|Back]]
*pseudo  memberanous colitis
**[[Elbow|Elbows]]
**[[Hip (anatomy)|Hips]]
**Shin
**[[Knee|Knees]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Somatization]]
*[[Depression]]
*IBS
| style="background: #F5F5F5; padding: 5px;" | ---
| style="background: #F5F5F5; padding: 5px;" |
*Presence of [[tenderness]] in soft-tissue anatomic locations
| style="background: #F5F5F5; padding: 5px;" |
*Non specific
*Normal [[Blood, Sweat & Tea|Blood]] and [[Urine|urine test]] (mandatory to rule out other diseases)
| style="background: #F5F5F5; padding: 5px;" |
*P-wave dispersions (Pd)
| style="background: #F5F5F5; padding: 5px;" | ---
| style="background: #F5F5F5; padding: 5px;" | ---
|- style="background: #DCDCDC; padding: 5px;" |
![[Rheumatoid arthritis]]<ref name="pmid23335586">{{cite journal |vauthors=Rodríguez-Henríquez P, Solano C, Peña A, León-Hernández S, Hernández-Díaz C, Gutiérrez M, Pineda C |title=Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint |journal=Arthritis Care Res (Hoboken) |volume=65 |issue=7 |pages=1177–82 |date=July 2013 |pmid=23335586 |doi=10.1002/acr.21958 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
| style="background: #F5F5F5; padding: 5px;" |Years
| style="background: #F5F5F5; padding: 5px;" |Symmetrical joint pain in
*Wrist
*Fingers
*[[Knee|Knees]]
*Feet
*Ankles
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*Extra-articular involvement of other organ systems
*Gastric perforation
*[[Carpal tunnel syndrome]]
*Colon cancer
*[[Tarsal tunnel syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Old age
* Genetic predisposition
* Alcohol abuse
* Smoking
* Smoking
* Autoimmune conditions
* Microbiata and infections
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*Reduced grip strength
*Hypotension
*[[Rheumatoid nodules]]
*Abdominal tenderness 
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*Positive Rheumatic Factor
*Electrolyte disturbance
*Anti-CCP body 
*Leukocytosis
*Synovial fluid analysis: WBC between 1500 and 25,000/cubicmm, low glucose, low C3 and C4 complement level.
*Thrombocytosis
*Anemia
*Mild leukocytosis
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*ECG is done rule out the heart failure as RA is one of the causes of heart failure
* T-wave inversion
| style="background: #F5F5F5; padding: 5px;" |
* ST-segment depression
*Plain film radiography: periarticular osteopenia, joint space narrowing, and bone erosions
*  ST-segment elevation rarely
*MRI: Bone erosions
* Q-waves
*Ultrasonography: Degree of inflammation and the volume of inflamed tissue
| style="background: #F5F5F5; padding: 5px;" | ---
|- style="background: #DCDCDC; padding: 5px;" |
![[Ankylosing spondylitis]]<ref name="pmid22798267">{{cite journal |vauthors=Ramonda R, Lorenzin M, Lo Nigro A, Vio S, Zucchetta P, Frallonardo P, Campana C, Oliviero F, Modesti V, Punzi L |title=Anterior chest wall involvement in early stages of spondyloarthritis: advanced diagnostic tools |journal=J. Rheumatol. |volume=39 |issue=9 |pages=1844–9 |date=September 2012 |pmid=22798267 |doi=10.3899/jrheum.120107 |url=}}</ref><ref name="pmid23678156">{{cite journal |vauthors=Wendling D, Prati C, Demattei C, Loeuille D, Richette P, Dougados M |title=Anterior chest wall pain in recent inflammatory back pain suggestive of spondyloarthritis. data from the DESIR cohort |journal=J. Rheumatol. |volume=40 |issue=7 |pages=1148–52 |date=July 2013 |pmid=23678156 |doi=10.3899/jrheum.121460 |url=}}</ref><ref name="pmid1488919">{{cite journal |vauthors=Jurik AG |title=Seronegative anterior chest wall syndromes. A study of the findings and course at radiography |journal=Acta Radiol Suppl |volume=381 |issue= |pages=1–42 |date=1992 |pmid=1488919 |doi= |url=}}</ref><ref name="pmid19604431">{{cite journal |vauthors=Guglielmi G, Cascavilla A, Scalzo G, Salaffi F, Grassi W |title=Imaging of sternocostoclavicular joint in spondyloarthropaties and other rheumatic conditions |journal=Clin. Exp. Rheumatol. |volume=27 |issue=3 |pages=402–8 |date=2009 |pmid=19604431 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
| style="background: #F5F5F5; padding: 5px;" |Years
| style="background: #F5F5F5; padding: 5px;" |Intermittent pain in
*[[Vertebral column|Spine]] joint
*[[Sacroiliac joint|Sacroiliac]] joint
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*Patients with [[Human leukocyte antigen|HLA]]-27 variant
*[[Computed tomography|CT]]: Gastrointestinal inflamation
*Extra-articular joint involvements
*[[Restrictive lung disease|Restrictive pulmonary disease]]
*Acute coronary syndromes (ACS), strokes, venous thromboembolism, conduction abnormalities
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Genetics (Monozygotic twins)
*CT Scan
| style="background: #F5F5F5; padding: 5px;" |
*Colonoscopy
*[[Tenderness]] of the SI
*biopsy
*Limited spinal [[Range of motion|ROM]]
*[[Schober's test|Schober test]]
| style="background: #F5F5F5; padding: 5px;" |
*↑ESR
*↑CRP
*↑ALP
*↑IgA
*[[Antigen]] HLA-27 positive
*Negative Rheumatic Factor
| style="background: #F5F5F5; padding: 5px;" |
*ECG is done to rule out conductions defects and aortic insufficiency
| style="background: #F5F5F5; padding: 5px;" |
*Plain radiography: Erosions, ankylosis, changes in joint width, or sclerosis.
*Magnetic resonance imaging (MRI): Osteitis" or "bone marrow edema" (BME)
| style="background: #F5F5F5; padding: 5px;" |
*Plain films of the sacroiliac joints
|- style="background: #DCDCDC; padding: 5px;" |
![[Psoriatic arthritis]]<ref name="pmid1488919">{{cite journal |vauthors=Jurik AG |title=Seronegative anterior chest wall syndromes. A study of the findings and course at radiography |journal=Acta Radiol Suppl |volume=381 |issue= |pages=1–42 |date=1992 |pmid=1488919 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
| style="background: #F5F5F5; padding: 5px;" |Years
| style="background: #F5F5F5; padding: 5px;" |Asymmetrical intermittent pain in
*[[Interphalangeal articulations of hand|Interphalangeal joints]]
*Nails
*Wrist
*[[Knee|Knees]]
*Ankles
*Lower [[Human back|Back]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*[[Psoriasis]]
*[[Enthesitis]]
*[[Tenosynovitis]]
*[[Dactylitis]]
| style="background: #F5F5F5; padding: 5px;" |
* Psoriasis
* HLA-B*27 positive
| style="background: #F5F5F5; padding: 5px;" |
*[[Dactylitis]] with sausage [[digits]] 
*Onycholysis
*Pitting edema
*Ocular involvement
| style="background: #F5F5F5; padding: 5px;" |Non specific
| style="background: #F5F5F5; padding: 5px;" |
*Longer PR interval 
| style="background: #F5F5F5; padding: 5px;" |
*X-ray: "pencil-in-cup" deformity, erosive changes and new bone formation, lysis of the terminal phalanges; fluffy periostitis
*MRI: Detects articular, periarticular, and soft-tissue inflammation, enthesitis
| style="background: #F5F5F5; padding: 5px;" |
*X-ray
|- style="background: #DCDCDC; padding: 5px;" |
!Sternocostoclavicular [[hyperostosis]] (SAPHO syndrome)<ref name="pmid1488919">{{cite journal |vauthors=Jurik AG |title=Seronegative anterior chest wall syndromes. A study of the findings and course at radiography |journal=Acta Radiol Suppl |volume=381 |issue= |pages=1–42 |date=1992 |pmid=1488919 |doi= |url=}}</ref><ref name="pmid8484129">{{cite journal |vauthors=Saghafi M, Henderson MJ, Buchanan WW |title=Sternocostoclavicular hyperostosis |journal=Semin. Arthritis Rheum. |volume=22 |issue=4 |pages=215–23 |date=February 1993 |pmid=8484129 |doi= |url=}}</ref><ref name="pmid19772827">{{cite journal |vauthors=Magrey M, Khan MA |title=New insights into synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome |journal=Curr Rheumatol Rep |volume=11 |issue=5 |pages=329–33 |date=October 2009 |pmid=19772827 |doi= |url=}}</ref><ref name="pmid19479702">{{cite journal |vauthors=Colina M, Govoni M, Orzincolo C, Trotta F |title=Clinical and radiologic evolution of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: a single center study of a cohort of 71 subjects |journal=Arthritis Rheum. |volume=61 |issue=6 |pages=813–21 |date=June 2009 |pmid=19479702 |doi=10.1002/art.24540 |url=}}</ref><ref name="pmid23597971">{{cite journal |vauthors=Carneiro S, Sampaio-Barros PD |title=SAPHO syndrome |journal=Rheum. Dis. Clin. North Am. |volume=39 |issue=2 |pages=401–18 |date=May 2013 |pmid=23597971 |doi=10.1016/j.rdc.2013.02.009 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
| style="background: #F5F5F5; padding: 5px;" |Years
| style="background: #F5F5F5; padding: 5px;" |Recurrent and multifocal pain in
[[Sternoclavicular articulation|Sternoclavicular]] joint
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*Palmoplantar [[pustulosis]] (PPP)
| style="background: #F5F5F5; padding: 5px;" |
Positive family history of:
* Spondyloarthritis
* IBD
* Psoriasis
* Rheumatoid arthritis
* Other autoimmune/autoinflammatory disease
| style="background: #F5F5F5; padding: 5px;" |
*Hyperostosis
*Osteitis
*Synovitis
*Pustular eruptions
*Inflammatory nodules or plaques
| style="background: #F5F5F5; padding: 5px;" |
*[[Serology|Serologic]] testing to exclude other diseases
*Non specific
| style="background: #F5F5F5; padding: 5px;" |
*ECG is done to rule out conductions defects and aortic insufficiency
| style="background: #F5F5F5; padding: 5px;" |
*Plain radiography: Hyperostotic changes (thickening of periosteum, cortex, and endosteum), sclerotic lesions, osteolysis, periosteal reaction, and osteoproliferation
*Bone scan: "bull's head" change
*Magnetic resonance imaging: Osteitis and soft tissue involvement
*Fluorodeoxyglucose positron emission tomography (FDG-PET)/CT: Differentiates active versus inactive lesions 
| style="background: #F5F5F5; padding: 5px;" |
*Bone scan
|- style="background: #DCDCDC; padding: 5px;" |
![[Systemic lupus erythematosus]]<ref name="pmid6749397">{{cite journal |vauthors=Turner-Stokes L, Turner-Warwick M |title=Intrathoracic manifestations of SLE |journal=Clin Rheum Dis |volume=8 |issue=1 |pages=229–42 |date=April 1982 |pmid=6749397 |doi= |url=}}</ref> <ref name="pmid5015911">{{cite journal |vauthors=Hunder GG, McDuffie FC, Hepper NG |title=Pleural fluid complement in systemic lupus erythematosus and rheumatoid arthritis |journal=Ann. Intern. Med. |volume=76 |issue=3 |pages=357–63 |date=March 1972 |pmid=5015911 |doi= |url=}}</ref><ref name="pmid17283581">{{cite journal |vauthors=Porcel JM, Ordi-Ros J, Esquerda A, Vives M, Madroñero AB, Bielsa S, Vilardell-Tarrés M, Light RW |title=Antinuclear antibody testing in pleural fluid for the diagnosis of lupus pleuritis |journal=Lupus |volume=16 |issue=1 |pages=25–7 |date=2007 |pmid=17283581 |doi=10.1177/0961203306074470 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
| style="background: #F5F5F5; padding: 5px;" |Years
| style="background: #F5F5F5; padding: 5px;" |
*Skin
*[[Joint|Joints]] (fingers, wrist, knees)
*[[Kidney|Kidneys]]
*SLE can affect any organ of the body
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Human leukocyte antigen|HLA]]-genetic mutations
*[[Female]] gender
*Being younger than 50 
| style="background: #F5F5F5; padding: 5px;" |
* Autoimmune conditions
* Genetic predisposition
* Positive family history
| style="background: #F5F5F5; padding: 5px;" |
*[[Malar rash]]
*[[Photosensitive]] [[rash]]
*[[Discoid lupus|Discoid rash]]
*[[Arthritis]] of the [[Proximal interphalangeal joints|proximal interphalangeal (PIP)]] and [[Metacarpophalangeal joint|metacarpophalangeal (MCP) joints]] of the [[hands]]
*[[Pleural friction rub|Pleuro-pericardial friction rubs]]
*[[Systolic murmurs]]
| style="background: #F5F5F5; padding: 5px;" |
*Elevation of [[Autoantibody|autoantibodies]] ([[Antinuclear antibodies|ANA]], [[Anti-dsDNA antibody|anti-dsDNA]], [[Anti-SM antibody|anti-SM]], [[Antiphospholipid antibodies|antiphospholipid]])
*[[Complement]] levels decreased
*Anemia
| style="background: #F5F5F5; padding: 5px;" |
* [[Sinus tachycardia]], [[ST segment changes]], and [[Ventricular arrhythmias|ventricular conduction disturbances]]
| style="background: #F5F5F5; padding: 5px;" |
*Related to specific organ involvent
| style="background: #F5F5F5; padding: 5px;" |
*Anti-dsDNA antibody test
|- style="background: #DCDCDC; padding: 5px;" |
![[Relapsing polychondritis]]<ref name="pmid23597963">{{cite journal |vauthors=Chopra R, Chaudhary N, Kay J |title=Relapsing polychondritis |journal=Rheum. Dis. Clin. North Am. |volume=39 |issue=2 |pages=263–76 |date=May 2013 |pmid=23597963 |doi=10.1016/j.rdc.2013.03.002 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
| style="background: #F5F5F5; padding: 5px;" |Years
| style="background: #F5F5F5; padding: 5px;" |Intermittent pain in:
*[[Tissue (biology)|Tissues]] that cover the end of the [[Joint|joints]]
*[[Cartilage]] of costal rib
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Hodgkin's lymphoma|Hodkin's lymphoma]]
*[[Myelodysplastic syndrome|Myelodysplastic]] syndromes
*[[Digestive disease|Gastrointestinal disorders]]
*Type 1 [[Diabetes mellitus]]
*[[Auricular appendage|Auricular]] [[chondritis]]
| style="background: #F5F5F5; padding: 5px;" |
* Autoimmune diseases
| style="background: #F5F5F5; padding: 5px;" |
*[[Physical examination|Physical examinations]] findings are seen related to [[nasal]] [[chondritis]], [[ocular]] [[inflammation]], [[cardiovascular disease]], [[skin disease]], [[CNS]] and [[Pulmonary|pulmonary system]]
| style="background: #F5F5F5; padding: 5px;" |
*Negative [[Rheumatoid factor|rheumatoid]] factor
*Anti-type II collagen antibodies
*Antineutrophil cytoplasmic antibodies
| style="background: #F5F5F5; padding: 5px;" |
* ECG is done to rule out the cardiovascular complications of this disease
| style="background: #F5F5F5; padding: 5px;" |
*Non specific
*Related to specific organ involvent
| style="background: #F5F5F5; padding: 5px;" |
*No gold standard test for this disease
|- style="background: #DCDCDC; padding: 5px;" |
|Psychiatric
![[Panic attack]]/ Disorder<ref name="pmid10906353">{{cite journal |vauthors=Fleet RP, Martel JP, Lavoie KL, Dupuis G, Beitman BD |title=Non-fearful panic disorder: a variant of panic in medical patients? |journal=Psychosomatics |volume=41 |issue=4 |pages=311–20 |date=2000 |pmid=10906353 |doi=10.1176/appi.psy.41.4.311 |url=}}</ref><ref name="pmid7954018">{{cite journal |vauthors=Fleet RP, Dupuis G, Marchand A, Burelle D, Beitman BD |title=Panic disorder, chest pain and coronary artery disease: literature review |journal=Can J Cardiol |volume=10 |issue=8 |pages=827–34 |date=October 1994 |pmid=7954018 |doi= |url=}}</ref><ref name="pmid8068393">{{cite journal |vauthors=Simpson RJ, Kazmierczak T, Power KG, Sharp DM |title=Controlled comparison of the characteristics of patients with panic disorder |journal=Br J Gen Pract |volume=44 |issue=385 |pages=352–6 |date=August 1994 |pmid=8068393 |pmc=1238951 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*History of [[Depression]]
*[[Panic attack|Panic attacks]]
*[[Agoraphobia]]
| style="background: #F5F5F5; padding: 5px;" |
*Psychiatric disorders
| style="background: #F5F5F5; padding: 5px;" |
*Anxious
*Tachypneic
| style="background: #F5F5F5; padding: 5px;" |
*Thyroid function tests
*Complete blood count
*Chemistry panel
| style="background: #F5F5F5; padding: 5px;" |
*Sinus Tachycardia
| style="background: #F5F5F5; padding: 5px;" |
*No any specific radiographic test is done
| style="background: #F5F5F5; padding: 5px;" | ---
|- style="background: #DCDCDC; padding: 5px;" |
| rowspan="2" |
Others
!Substance abuse
([[Cocaine abuse|Cocaine]])<ref name="pmid26039070">{{cite journal |vauthors=Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS |title=Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III |journal=JAMA Psychiatry |volume=72 |issue=8 |pages=757–66 |date=August 2015 |pmid=26039070 |pmc=5240584 |doi=10.1001/jamapsychiatry.2015.0584 |url=}}</ref><ref name="pmid17592911">{{cite journal |vauthors=Cosci F, Schruers KR, Abrams K, Griez EJ |title=Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship |journal=J Clin Psychiatry |volume=68 |issue=6 |pages=874–80 |date=June 2007 |pmid=17592911 |doi= |url=}}</ref><ref name="pmid2183544">{{cite journal |vauthors=George DT, Nutt DJ, Dwyer BA, Linnoila M |title=Alcoholism and panic disorder: is the comorbidity more than coincidence? |journal=Acta Psychiatr Scand |volume=81 |issue=2 |pages=97–107 |date=February 1990 |pmid=2183544 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Acute (hours)
| style="background: #F5F5F5; padding: 5px;" |Minutes to hours
| style="background: #F5F5F5; padding: 5px;" |Pressure like pain in the center of chest
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Anxiety]]
*[[Dyspnea]]
*[[Nausea and vomiting|Nausea]]
*[[Palpitation|Palpitations]]
| style="background: #F5F5F5; padding: 5px;" |
*Psychiatric disorders
| style="background: #F5F5F5; padding: 5px;" |
*[[Signs]] of [[injection]] [[drug use]]
*[[Signs]] of [[drug]] [[inhalation]]
*Poor [[personal hygiene]]
| style="background: #F5F5F5; padding: 5px;" |
*Serum [[Cardiac biomarkers|biomarkers]] ([[Troponin I]], [[Troponin T]])
*Toxicologic tests or drug screens of bodily fluids (blood, urine, saliva) and hairs
| style="background: #F5F5F5; padding: 5px;" |
**QT prolongation
**Sinus Tachycardia
**Arrhythmias
**Cardiac conduction abnormalities
| style="background: #F5F5F5; padding: 5px;" | ---
| style="background: #F5F5F5; padding: 5px;" |
*Gold standard test depends on the type of substance is abuse
|- style="background: #DCDCDC; padding: 5px;" |
![[Herpes Zoster]]<ref name="pmid17143845">{{cite journal |vauthors=Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ |title=Recommendations for the management of herpes zoster |journal=Clin. Infect. Dis. |volume=44 Suppl 1 |issue= |pages=S1–26 |date=January 2007 |pmid=17143845 |doi=10.1086/510206 |url=}}</ref><ref name="pmid8545018">{{cite journal |vauthors=Oxman MN |title=Immunization to reduce the frequency and severity of herpes zoster and its complications |journal=Neurology |volume=45 |issue=12 Suppl 8 |pages=S41–6 |date=December 1995 |pmid=8545018 |doi= |url=}}</ref><ref name="pmid15897984">{{cite journal |vauthors=Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF |title=Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002 |journal=J. Infect. Dis. |volume=191 |issue=12 |pages=2002–7 |date=June 2005 |pmid=15897984 |doi=10.1086/430325 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Acute or Chronic
| style="background: #F5F5F5; padding: 5px;" |Variable
| style="background: #F5F5F5; padding: 5px;" |Burning pain on
*Chest
*Upper back
*Lower back
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
*People who had [[chickenpox]]
| style="background: #F5F5F5; padding: 5px;" |
* Immunosuppression
| style="background: #F5F5F5; padding: 5px;" |
*[[Painful]] grouped herpetiform [[vesicles]] on an [[Erythematous|erythematous base]] distributed in a single [[dermatome]]
| style="background: #F5F5F5; padding: 5px;" |
*Viral culture
*Direct immunofluorescence testing,
*Polymerase chain reaction assay (PCR)
| style="background: #F5F5F5; padding: 5px;" |
*ECG is done to rule out other cardiovascular causes of chest pain
| style="background: #F5F5F5; padding: 5px;" |
*Magnetic resonance imaging (MRI): To rule out encephalitis
| style="background: #F5F5F5; padding: 5px;" |
*Viral tissue culture
|}
|}
</small></small>
</small></small>

Latest revision as of 13:14, 16 April 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Syed Musadiq Ali M.B.B.S.[3] Ramyar Ghandriz MD[4]

Overview

Shock is a clinical syndrome resulting from the hypoperfusion of the tissues. Regardless of the underlying cause, this hypoperfusion leads to the failure to meet tissues' nutritional and oxygen needs, causing cellular dysfunction. The affected tissues lead to the production and release of inflammatory mediators that will further jeopardize perfusion through changes in the vasculature. The results of these changes are organ failure and death if treatment in not timely applied. According to the underlying cause, there will be different types of shock, which will have similar presentations. It is mandatory to determine the underlying cause of the condition so that proper treatment may be started. Cardiogenic shock is a clinical condition, defined as a state of systemic hypoperfusion originated in cardiac failure, in the presence of adequate intravascular volume, typically followed by hypotension, which leads to insufficient ability to meet oxygen and nutrient demands of organs and other peripheral tissues. It may range from mild to severe hypoperfusion and may be defined in terms of hemodynamic parameters, which according to most studies, means a state in which systolic blood pressure is persistently < 90 mm Hg or < 80 mm Hg, for longer than 1 hour, with adequate or elevated left and right ventricular filling pressures that does not respond to isolated fluid administration, is secondary to cardiac failure and occurs with signs of hypoperfusion (oliguria, cool extremities, cyanosis and altered mental status) or a cardiac index of < 2.2 L/min/m² (on inotropic, vasopressor or circulatory device support) or < 1.8-2.2 L/min/m² (off support) and pulmonary artery wedge pressure > 18 mm Hg.

Differential Diagnosis

Depending on the author and the source used there will be different ways of organizing the types of shock. Sometimes it might be difficult to differentiate, from the clinical standpoint, two types of shock since components of each type may combine in a single patient. The clinical presentation of shock is usually the result of a complexity of processes, such as the sympathetic and endocrine responses to hypoperfusion, along with manifestations of organ failure. Patients who present with signs and symptoms of hypoperfusion following a diagnosed or suspected myocardial infarction, are commonly suffering a cardiogenic shock as a complication of the MI. However, other clinical scenarios, not related to acute MI, may present similarly:[1][2]

Differences to be noted include:

<math>\mbox{Shock index} = \frac{heart\ rate}{systolic\ blood\ pressure}</math>

Other measures include: decreased ventricular preload, ventricular diastolic volumes and pressures, pulmonary wedge pressure and central venous pressure.

Classification of shock based on hemodynamic parameters. (CO, cardiac output; CVP; central venous pressure; PAD, pulmonary artery diastolic pressure; PAS, pulmonary artery systolic pressure; RVD, right ventricular diastolic pressure; RVS, right ventricular systolic pressure; SVO2, systemic venous oxygen saturation; SVR, systemic vascular resistance.)[11][12]
Type of Shock Etiology CO SVR PCWP CVP SVO2 RVS RVD PAS PAD
Cardiogenic Acute Ventricular Septal Defect ↓↓ N — ↑ ↑↑ ↑ — ↑↑ N — ↑ N — ↑ N — ↑
Acute Mitral Regurgitation ↓↓ ↑↑ ↑ — ↑↑ N — ↑
Myocardial Dysfunction ↓↓ ↑↑ ↑↑ N — ↑ N — ↑ N — ↑
Right Ventricular Infarction ↓↓ N — ↓ ↑↑ ↓ — ↑ ↓ — ↑ ↓ — ↑
Obstructive Pulmonary Embolism ↓↓ N — ↓ ↑↑ ↓ — ↑ ↓ — ↑ ↓ — ↑
Cardiac Tamponade ↓ — ↓↓ ↑↑ ↑↑ N — ↑ N — ↑ N — ↑
Distributive Septic Shock N — ↑↑ ↓ — ↓↓ N — ↓ N — ↓ ↑ — ↑↑ N — ↓ N — ↓
Anaphylactic Shock N — ↑↑ ↓ — ↓↓ N — ↓ N — ↓ ↑ — ↑↑ N — ↓ N — ↓
Hypovolemic Volume Depletion ↓↓ ↓↓ ↓↓ N — ↓ N — ↓


The following table outlines the major differential diagnoses of Shock on the basis of clinical manifestations..[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]


Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell); Coronary CT angiography (CCTA); multidetector row scanners (MDCT); Cardiovascular magnetic resonance — CMRI; Myocardial perfusion imaging (MPI); single-photon emission CT (SPECT); Positron emission tomography (PET) scanning; Magnetic resonance (MR) angiography, Computed tomographic (CT) angiography, and Transesophageal echocardiography (TEE), late gadolinium enhancement (LGE); right ventricular hypertrophy (RVH), right atrial enlargement (RAE), functional tricuspid regurgitation (TR), Pulmonary artery systolic pressure (PASP; adenosine deaminase (ADA); Serum amyloid A (SAA), soluble interleukin-2 receptor (sIL2R); High-resolution CT (HRCT) scanning

Differentials on the basis of Etiology Disease Clinical manifestations Diagnosis
Symptoms Risk factors Physical exam Lab Findings EKG Imaging Gold standard
Onset Duration Quality of Pain Cough Fever Dyspnea Weight loss Associated Features
Myocardial Infarction[13][14][15][16] Acute Commonly > 20 minutes - - + -
  • ST elevation MI (STEMI)
  • Non-ST elevation MI (NSTEMI) or Non Q wave
  • CCTA combined with MPI
Cardiac
Aortic Dissection[49][50] Sudden severe progressive pain (common) or chronic (rare) Variable
  • Tearing, ripping sensation, knife like
- - + -
  • Nonspecific ST and T wave changes
Aortic intramural hematoma Sudden severe progressive pain (common) or chronic (rare) Variable
  • Tearing, ripping sensation, knife like
- - + -
  • Nonspecific ST and T wave changes
Penetrating atherosclerotic aortic ulcer[51][52][53] Sudden severe pain Variable
  • Tearing, ripping sensation, knife like
- - + -

_

_

Pericardial Tamponade[54][55] Acute or subacute May last for hours to days +/- + + - EKG findings:
Myocarditis[56][57][58] Acute or subacute Variable +/- + + -
Hypertrophic cardiomyopathy[59][60][61] Acute or subacute Variable Typical or atypical chest pain - - + - Non-specific

Echocardiography:

Genetic testing for HCM
Stress (takotsubo)

Cardiomyopathy[62][63][64][65]

Acute Commonly > 20 minutes - - + -
  • Setting of physical or emotional stress or critical illness
Stress
Aortic Stenosis[66][67][68] Acute, recurrent episodes of angina 2-10 minutes - - + -
Heart Failure[69][70][71] Subacute or chronic Variable
  • Dull
  • Left sided chest pain
+ +/- + + Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes
Differentials on the basis of Etiology Disease Clinical manifestations Diagnosis
Symptoms Risk factors Physical exam Lab Findings EKG Imaging Gold standard
Onset Duration Quality of Pain Cough Fever Dyspnea Weight loss Associated Features
Pulmonary Pulmonary Embolism[72][73] Acute May last minutes to hours + +/- + -  Hormone replacement therapy

Cancer Oral contraceptive pills Stroke  Pregnancy Postpartum  Prior history of VTE Thrombophilia 

Spontaneous Pneumothorax[74][75] Acute May last minutes to hours - - + -
  • Rightward shift in the mean electrical axis
  • Loss of precordial R waves
  • Diminution of the QRS voltage
  • Precordial T wave inversions
  • CXR: White visceral pleural line on the chest radiograph
  • CT: small amounts of intrapleural gas, atypical collections of pleural gas, and loculated pneumothoraces
  • CT scan
Tension Pneumothorax[76][77] Acute May last minutes to hours - - + -
  • Trauma
  • Significant elevation of the ST-T segment from leads V1 to V4
Pleural Effusion[78][79][80] Acute or subacute or chronic Variable + +/- + +/-
  • Typically not indicated
Acute chest syndrome (Sickle cell anemia)[81][82][83] Acute May last minutes to hours
  • Chest tightness
+ +/- + -
  • EKG typically not indicated
---
Differentials on the basis of Etiology Disease Clinical manifestations Diagnosis
Symptoms Risk factors Physical exam Lab Findings EKG Imaging Gold standard
Onset Duration Quality of Pain Cough Fever Dyspnea Weight loss Associated Features
Gastrointestinal Perforated Peptic Ulcer[84][85][86] Acute +/- - - +/-
  • Not any auscultatory findings associated with this disease
  • Enamel erosion or other dental manifestations
Esophagitis[87][88][89] Acute Variable + + - +/-
  • No auscultatory finding
Esophageal Perforation[18] Acute Minutes to hours
  • Burning
  • Upper abdominal
- +/- + -
    • Confirmed by water-soluble contrast esophagram
Mediastinitis[90][91][92][93] Acute, Chronic Variable
  • Retrosternal irritation
+/- + + -
  • Nonspecific
  • Infection
  • Esophageal perforation
  • Post operative complication
  • Positive organisms in sternal culture
  • Leukocytosis
  • Positive blood cultures
  • Diffuse ST elevation
  • CT: Localize the infection and extent of spread
  • MRI: Assesses vascular involvement and complications
CT scan
Pancreatitis[94][95][96][97][98] Acute, Chronic Variable - + + +/-
  • Alcohol abuse
  • Smoking
  • Genetic predisposition
  •  Tachypnea
  • Hypoxemia
  • Hypotension
  • Cullen's sign
  • Grey Turner sign 
  • T-wave inversion
  • ST-segment depression
  •  ST-segment elevation rarely
  • Q-waves
  • CT: focal or diffuse enlargement of the pancreas
  • MRI: Pancreatic enlargement
  • CT Scan
IBD[99] Acute, Chronic Variable
  • Painful bowl movments
  • Bloody diarrhea
  • pus or mucus in the stool
  • Fistula
  • sepsis
  • pseudo memberanous colitis
- + + +
  • Gastric perforation
  • Colon cancer
  • Genetic predisposition
  • Alcohol abuse
  • Smoking
  • Microbiata and infections
  • Hypotension
  • Abdominal tenderness 
  • Electrolyte disturbance
  • Leukocytosis
  • T-wave inversion
  • ST-segment depression
  •  ST-segment elevation rarely
  • Q-waves
  • CT: Gastrointestinal inflamation
  • CT Scan
  • Colonoscopy
  • biopsy

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