Chest pain differential diagnosis: Difference between revisions

Latest revision as of 22:35, 5 December 2022

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2] Amresh Kumar MD [3]

An expert algorithm to assist in the diagnosis of Chest pain can be found here.

To go back to the main page on Unstable angina, click here.

Overview

There are several life-threatening causes of chest pain which need to be evaluated for first, which include; myocardial infarction, aortic dissection, esophageal rupture, pulmonary embolism, and tension pneumothorax. The other possible causes of chest pain can be determined by carefully assessing the nature of the pain, and obtaining a thorough patient history.

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines^[1]

Recommendation for Evaluation of Acute Chest Pain With Suspected Noncardiac Causes


Class I
"1. Patients with acute chest pain should be evaluated for noncardiac causes if they have persistent or recurring symptoms despite a negative stress test or anatomic cardiac evaluation, or a low-risk designation by a CDP. (Level of Evidence: C-EO)"

Differential Diagnosis of Chest Pain

5 Life Threatening Diseases to Exclude Immediately

The frequency of conditions exclusive of acute myocardial infarction in a decreasing order is:^[10]

Gastroesophageal disease
Ischemic heart disease (angina)
Chest wall syndromes

Differential Diagnosis of Non-Cardiac Chest pain
Respiratory Pulmonary embolism Pneumothorax Hemothorax Pneumomediastinum Pneumonia Bronchitis Pleural irritation Malignancy
Gastrointestinal Cholecystitis Pancreatitis Hiatal hernia Gastroesophageal reflux disease, gastritis, esophagitis Peptic ulcer disease Esophageal spasm Dyspepsia
Chest wall Costochondritis Chest wall trauma, inflammation Herpes Zoster (shingles Cervical radiculopathy Breast disease Rib fracture Musculoskeletal injury, spasm
Psychological Panic disorder Anxiety Clinical depression Somatization disorder Hypochondria
Other Hyperventilation syndrome Carbon monoxide poisoning Sarcoidosis Lead poisoning Prolapsed intervertebral disc Thoracic outlet syndrome Side effect of medications (5-fluorouracil) Sickle cell crisis

The above table adopted from 2021 AHA/ACC/ASE Guideline^[11]

Differentiating the Life-Threatening and Ischemic Causes of Chest Pain from other Disorders

To review the differential diagnosis of chest pain, click here.

To review the differential diagnosis of chest pain and cough, click here.

To review the differential diagnosis of chest pain and fever, click here.

To review the differential diagnosis of chest pain and dyspnea, click here.

To review the differential diagnosis of chest pain and weight loss, click here.

To review the differential diagnosis of chest pain, cough, and fever, click here.

To review the differential diagnosis of chest pain, cough, and dyspnea, click here.

To review the differential diagnosis of chest pain, cough, and weight loss, click here.

To review the differential diagnosis of chest pain, fever, and dyspnea, click here.

To review the differential diagnosis of chest pain, fever, and weight loss, click here.

To review the differential diagnosis of chest pain, dyspnea, and weight loss, click here.

The following table outlines the major differential diagnoses of chest pain:^[12]^[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]

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	Risk Factors	Physical Exam	Lab Findings	EKG	Imaging	Gold Standard
	Stable Angina^[48]	Sudden (acute)	2-10 minutes	Heaviness/pressure/ tightness/squeezing/ burning (Levine's sign) Retrosternal or left sided chest pain	-	-	+/-	-	Nausea and vomiting Diaphoresis	Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes	Transient third heart sound (S3 - ventricular filling sound) and fourth heart sound (S4 - atrial filling sound)	Cardiac enzymes normal	Exercise EKG: ST-segment depression	Exercise Stress Testing: Decreased myocardial perfusion Transthoracic echocardiography: Ejection fraction <50 percent	Coronary angiography
	COVID-19-associated myocardial infarction^[49]	Sudden (acute)	Commonly > 20 minutes	Retrosternal or left sided chest pain Same as stable angina but often more severe	+/-	+/-	+/-	-	Nausea and vomiting Diaphoresis	Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes	Transient third heart sound (S3 - ventricular filling sound) and fourth heart sound (S4 - atrial filling sound)	Cardiac enzymes elevated	ST elevation MI (STEMI) Non-ST elevation MI (NSTEMI) or Non Q wave	Exercise Stress Testing: Decreased myocardial perfusion Transthoracic echocardiography: Localized wall motion abnormalities Diffuse hypokinesia Left ventricular ejection fraction was lower than 50% in about 61% of the individuals	Coronary angiography
	Unstable Angina^[50]^[51]^[52]	Acute	10-20 minutes	Same as stable angina but often more severe	-	-	+	-	Nausea and vomiting Diaphoresis Presyncope Palpitations	Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes	Reverse splitting of the second heart sound Rales or crackles Elevated jugular venous pressure	Cardiac biomarkers [Cardiac troponin I, cardiac troponin T and MB isoenzyme of creatine kinase (CK-MB)] normal	ST-depression New T wave inversions Transient ST-elevation	Echocardiography: Ejection fraction <50 percent Exercise Stress Testing: Decreased myocardial perfusion	Invasive coronary angiography
	Myocardial Infarction^[12]^[13]^[14]^[15]	Acute	Commonly > 20 minutes	Same as stable angina but often more severe	-	-	+	-	Nausea and vomiting Diaphoresis Presyncope Palpitations Lateral displacement of the apical impulse	Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes	Hypotension Tachycardia S4 gallop Paradoxical splitting of S2 Mitral regurgitation murmur	Elevated cardiac enzymes ↑B-Type Natriuretic Peptide	ST elevation MI (STEMI) Non-ST elevation MI (NSTEMI) or Non Q wave	Echocardiography: ↓ EF CCTA: Coronory artery stenosis CMRI: Coronory vessels stenosis MPI on SPECT or PET scanning: Decreased myocardial perfusion.	CCTA combined with MPI
Cardiac	Vasospastic/ Prinzmetal/ Variant Angina^[53]^[54]	Gradual in onset and offset	Episodic, gradual in onset and offset	Chest discomfort described as squeezing, tightness, pressure, constriction, strangling, burning, heart burn, fullness in the chest, a band-like sensation, knot in the center of the chest, lump in the throat, ache, and heavy weight on chest	-	-	+	-	Nausea, diaphoresis, dizziness, dyspnea, and palpitations Associated with other vasospastic disorders, such as Raynaud's phenomenon and migraine headache	Multiple drugs (ephedrine-based products, cocaine, marijuana, alcohol, butane, sumatriptan, and amphetamines) Food-born botulism Guide wire or balloon dilatation while doing PCI Magnesium deficiency	Tachycardia, hypertension, diaphoresis, and a gallop rhythm	Urine drug screen may be positive for cocaine or other drugs	Transient (less than 15 minutes) ischemic ST changes in multiple leads A tall and broad R wave, Disappearance of the S wave A taller T wave Negative U waves	Stress testing: normal noninvasive stress test, exercise-induced spasm with ST-segment elevation, Stress echocardiography with ergonovine provocation: Vasospasm of coronory vessels Coronary arteriography: Epicardial spasm	Coronary arteriography
	Aortic Dissection^[55]^[56]	Sudden severe progressive pain (common) or chronic (rare)	Variable	Tearing, ripping sensation, knife like	-	-	+	-	Focal neurologic deficit Hypotension	Hypertension Genetically mediated collagen disorders Preexisting aortic aneurysm Bicuspid aortic valve Aortic coarctation Turner syndrome Vasculitis (giant cell arteritis, Takayasu arteritis, rheumatoid arthritis, syphilitic aortitis)	Pulse deficit New diastolic murmur Diastolic decrescendo murmur Focal neurologic deficit Hypotension	D-dimer <500 ng/mL rules out aortic dissection ↑Soluble ST2 (sST2) Measurements of soluble elastin fragments, smooth muscle myosin heavy chain, high-sensitivity C-reactive protein, fibrinogen, and fibrillin fragments	Nonspecific ST and T wave changes	CXR: Mediastinal and/or aortic widening CTA: A compressed true lumen MRA: Detects differential flow between the true and false lumens, widening of the aorta with a thickened wall TEE: Intimal dissection flaps, true and false lumens, thrombosis in the false lumen Aortography: Distortion of the normal contrast column, Flow reversal or stasis into a false channel, Failure of major branches to fill, and Aortic valvular regurgitation	CT angiography Digital subtraction aortography (if high suspicion)
	Pericarditis^[57]^[58]^[59]	Acute or subacute	May last for hours to days	Sharp & localized retrosternal pain	+	+	+	-	Pericardial friction rub	HIV TB Immunosuppression Acute trauma	Pericardial friction rub heard with the diaphragm of stethoscope	Leukocytosis ↑Troponin level ↑Erythrocyte sedimentation rate ↑C-reactive protein level	EKG changes (typically widespread ST segment elevation or PR depressions)	Chest x-ray typically normal Echocardiogram: normal or pericardial effusion CT scan: Noncalcified pericardial thickening with pericardial effusion CMR: inflamed pericardium and myocarditis	Pericardiocentesis Pericardial biopsy
	Pericardial Tamponade^[60]^[61]	Acute or subacute	May last for hours to days	Sharp and stabbing retrosternal pain	+/-	+	+	-	Pulsus paradoxus Pericardial rub	HIV TB Immunosuppression Acute trauma	Kussmaul sign Beck triad Pulsus paradoxus	Creatine kinase and isoenzymes Abnormal LFTs Antinuclear antibody assay, erythrocyte sedimentation rate and rheumatoid factor HIV testing	EKG findings: Sinus tachycardia Low QRS voltage Electrical alternans	CXR: enlarged cardiac silhouette with clear lung fields Echocardiography: Chamber collapse, Respiratory variation in volumes and flows, IVC plethora Swan-Ganz Catheterization: Equilibration of average intracardiac diastolic pressures (usually between 10 and 30 mmHg)	Echocardiography
	Myocarditis^[62]^[63]^[64]	Acute or subacute	Variable	Sharp & localized retrosternal pain reflects associated pericarditis	+/-	+	+	-	Heart failure Sudden cardiac death Arrythmias	Ischemic heart disease Valvular heart disease	S3 and S4 gallop Cardiac murmurs Pericardial friction rub	Serum cardiac troponin levels ↑ BNP or NT-proBNP level	Nonspecific ST changes, single atrial or ventricular ectopic beats, complex ventricular arrhythmias	CXR: Normal to enlarged with or without pulmonary vascular congestion and pleural effusions Echo: Left ventricular dilation, changes in left ventricular geometry (eg, development of a more spheroid shape), and wall motion abnormalities CMR: T1 and T2 signal intensity consistent with edema, presence of LGE consistent with necrosis or scar Radionuclide ventriculography: ↓ EF Cardiac catheterization: Assessment of hemodynamic status	Endomyocardial biopsy
	Hypertrophic cardiomyopathy^[65]^[66]^[67]	Acute or subacute	Variable	Typical or atypical chest pain	-	-	+	-	HF Arrhythmias Syncope Acute hemodynamic collapse	Positive family history of sudden cardiac death Genetic mutation	S4 Systolic murmurs LV apical impulse Brisk carotid pulse ↑ JVP A parasternal lift	Non-specific	Prominent abnormal Q waves P wave abnormalities Left axis deviation Deeply inverted T waves	Echocardiography: LV hypertrophy Systolic anterior motion of the mitral valve, LVOT obstruction Cardiac catheterization Pressure gradient Augmentation of the gradient Aortic pressure Left ventricular pressure Left atrial or pulmonary capillary wedge pressure Coronary angiography Obstructive epicardial coronary artery disease Genetic testing for HCM: Sarcomere mutation in an athlete with a maximal LV wall thickness in the "grey zone"	Genetic testing for HCM
	Stress (takotsubo) Cardiomyopathy^[68]^[69]^[70]^[71]	Acute	Commonly > 20 minutes	Substernal heaviness or tightness	-	-	+	-	Setting of physical or emotional stress or critical illness	Stress	Murmurs and rales may be present on auscultation in the setting of acute pulmonary edema	Catecholamines transiently elevated ↑TnT level ↑BNP level	ST segment elevation ST depression QT interval prolongation, T wave inversion, abnormal Q waves	Radionuclide myocardial perfusion imaging: Transient perfusion abnormalities in the left ventricular apex	Ventriculography and invasive coronary angiography
	Aortic Stenosis^[72]^[73]^[74]	Acute, recurrent episodes of angina	2-10 minutes	Heaviness/pressure/ tightness/squeezing/ burning (Levine's sign) Retrosternal	-	-	+	-	Dyspnea and decreased exercise tolerance Dizziness and syncope Angina pectoris	HTN Old age	S2 is soft, single and paradoxically split A2 delayed and tends to occur simultaneously with P2 Aortic ejection click Fourth heart sound (S4) can also be heard Crescendo–decrescendo murmur	Schistiocytes on peripheral blood smear	Non specific (the voltage of the QRS complex is increased showing the presence of left ventricular hypertrophy)	Echocardiography: aortic leaflets thickened and calcified, ↑ pulmonary artery pressure) CMR: Myocardial fibrosis, evaluation of aortic anatomy and size MDCT: Degree of aortic valve calcification PET: Measures active mineralization which correlates with stenosis severity	Echocardiography
	Heart Failure^[75]^[76]^[77]	Subacute or chronic	Variable	Dull Left sided chest pain	+	+/-	+	+	Orthopnea Peripheral edema Hemoptysis	Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes	S3 Elevated JVP Peripheral edema	Hyponatremia Hypoalbuminemia ↑ Serum brain natriuretic peptide (BNP) or NT-proBNP level A mild elevation in serum bilirubin (total bilirubin <3 mg/dL)	EKG findings are specific according to each cause of heart failure Q waves, ST and T wave abnormalities in patients with prior MI New onset arrhythmias (atrial fibrillation and ventricular tachycardia)	CXR: Cardiomegaly Echocardiography: ↓ EF Right heart catheterization: Pulmonary capillary wedge pressure >20 mmHg, right atrial pressure ≥12 mmHg) and/or decreased cardiac index (≤2.2 L/min/m2	Echocardiography
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	Risk Factors	Physical Exam	Lab Findings	EKG	Imaging	Gold Standard
Pulmonary	Pulmonary Embolism^[78]^[79]	Acute	May last minutes to hours	Sharp or knifelike or pleuritic pain Localized to side of lesion	+	+/-	+	-	Hemoptysis History of venous thromboembolism or coagulation abnormalities.	Hormone replacement therapy Cancer Oral contraceptive pills Stroke Pregnancy Postpartum Prior history of VTE Thrombophilia	S3 or S4 gallop Low grade fever Tachycardia Tachypnea Hypoxia	↑D-dimer ≥500 ng/mL Arterial blood gases (Respiratory alkalosis) ↑Troponin levels Hypercoagulation workup	Tachycardia and nonspecific ST-segment and T-wave changes (70 percent) S1Q3T3 pattern New right bundle branch block Inferior Q-waves (leads II, III, and aVF)	Duplex Ultrasonography: DVT CXR: Westermark sign, Hampton hump, Palla's sign Echocardiography: RV dilation (ratio of apical 4-chamber RV diameter to left ventricle (LV) diameter > 0.9) RV systolic dysfunction Ventilation-Perfusion Scanning: High probability	CT pulmonary angiography
	Spontaneous Pneumothorax^[80]^[81]	Acute	May last minutes to hours	Sharp Localized pleuritic	-	-	+	-	Respiratory distress Tachypnea Asymmetric lung expansion Hyperresonance on percussion Decreased tactile fremitus Tachycardia Cardiac apical displacement	Smoking Positive family history Marfan syndrome Homocystinuria Thoracic endometriosis.	Decreased breath sounds on involved side Lung sounds transmitted from the unaffected hemithorax are minimal with auscultation at the midaxillary line Adventitious lung sounds (crackles, wheeze; an ipsilateral finding) Pulsus paradoxus	Respiratory alkalosis on ABGs	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^[82]^[83]	Acute	May last minutes to hours	Sharp Pleuritic	-	-	+	-	Hypotension Jugular venous distention Respiratory distress	Trauma	Decreased breath sounds on involved side Lung sounds transmitted from the unaffected hemithorax are minimal with auscultation at the midaxillary line Adventitious lung sounds (crackles, wheeze; an ipsilateral finding) Pulsus paradoxus	Respiratory alkalosis on ABGs	Significant elevation of the ST-T segment from leads V1 to V4	CXR: A distinct shift of the mediastinum to the contralateral side, collapse of the ipsilateral lung, and flattening or inversion of the ipsilateral hemidiaphragm	CT scan
	Pneumonia^[84]^[85]^[86]	Acute or chronic	Variable	Dull Localized to side of lesion	+	+	+	+/-	Altered mental status Tachycardia Rust-colored sputum Green sputum Red currant-jelly sputum Central cyanosis	Long hospital stay Ill contact exposure Aspiration	Wheezing Rhonchi Rales Decreased breath sounds Pleural friction rub	Arterial blood gas : Hypoxia, hypoxemia ↑ Procalcitonin Leukocytosis Sputum evaluation Positive blood cultures	Sinus tachycardia Nonspecific ST-segment or T-wave changes	CXR: Interstitial infiltrates, lobar consolidation, cavitation	CXR
	Tracheitis/ Bronchitis^[87]^[88]^[89]^[90]	Acute	Variable	Dull Substernal	+	+	+	-	Tachypnea Respiratory distress Hoarseness Dyspnea Cyanosis Sore throat Odynophagia Dysphonia	Aspiration Pneumonia	Inspiratory stridor (with or without expiratory stridor) Nasal flaring Wheezing	Gram stain of exudates: Neutrophils	Peaked P-wave	Radiography of the neck: Steeple sign Laryngotracheobronchoscopy: a normal epiglottis with subglottic narrowing, thick and purulent secretions in the trachea, pseudomembranes	Endoscopy
	Pleuritis	Acute or subacute or chronic	May last minutes to hours	Sharp Localized pleuritic	+	+	+	-	Sharp chest pain with breathing Itching in sites on the back Dizziness	Autoimmune conditions Infections	Tachypnea Tachycardia Pleural Rubs Decreased breath sounds	Leukocytosis Arterial blood gas (ABG): Hypoxia Thoracocentesis	EKG done to rule out other causes in differential diagnoses	Chest X Ray: Pleural fluid on one or both sides Computerized tomography (CT) scan: Pleural effusions	CXR
	Pulmonary Hypertension^[91]^[92]^[93]	Acute or subacute or chronic	Variable	Substernal pressure like	+	-	+	-	Dyspnea Symptoms of right heart failure (edema) Past history of heart murmur Deep venous thrombosis (DVT) Arthritis or arthralgias Rash	Smoking HF Heavy snoring Morbid obesity	The intensity of the pulmonic component of the second heart sound (P2) may be increased and the P2 may demonstrate fixed or paradoxical splitting. Systolic ejection murmur A right-sided fourth heart sound (S4) with a left parasternal heave	Abnormal Arterial blood gas Antinuclear antibody (ANA) levels Antineutrophil cytoplasmic antibody (ANCA) Brain natriuretic peptide (BNP of NT-proBNP) HIV testing Iron deficiency Pulmonary Function Testing Polysomnography	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	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,	Cardiac catheterization
	Pleural Effusion^[94]^[95]^[96]	Acute or subacute or chronic	Variable	Dull Pleuritic pain	+	+/-	+	+/-	Increasing lower extremity edema Orthopnea Paroxysmal nocturnal dyspnea Night sweats Hemoptysis	Pneumonia	Diminished or inaudible breath sounds Pleural friction rub Egophony (known as "E-to-A" changes)	Pleural fluid LDH levels above 1000 IU/L Nucleated cells - Lymphocytosis - Eosinophilia - Mesothelial cells Pleural fluid culture and cytology Pleural fluid antinuclear antibody and rheumatoid factor	Typically not indicated	Chest X Ray: Pleural fluid on one or both sides Computerized tomography (CT) scan: Detects small pleural effusions, ie, less than 10 mL and possibly as little as 2 mL of liquid in the pleural space, Thickening of the visceral and parietal pleura MRI: Characterize the content of pleural effusions	Computed tomography
	Asthma & COPD^[97]^[98]^[99]^[100]	Acute or subacute or chronic	Variable	Tightness	+	+/-	+	+/-	Cyanosis	Smoking HF HTN	Elevated jugular venous pulse (JVP) Hyperinflation (barrel chest) Peripheral edema Clubbing Wheezing Rhonchi Diffusely decreased breath sounds Coarse crackles beginning with inspiration	Leukocytosis Eosinophilia Respiratory alkalosis	Peaked P-wave Reduced amplitude of the QRS complexes Multifocal atrial tachycardia (MAT)	CXR: Hyperinflation Spirometry: ↓ FEV1, PEF, ↓ FEV1/FVC	Spirometry
	Pulmonary Malignancy^[101]^[102]^[103]^[104]	Chronic	Variable	Dull aching	+	+/-	+	+	Bone pain Fatigue Neurologic dysfunction Superior vena cava (SVC) obstruction Hoarseness Hemidiaphragm paralysis Dysphagia Paraneoplastic syndromes Hypercalcemia	Smoking Metastasis	Wheeze Crackles Depending upon complications caused by the spread of cancer	Hypercalcemia	EKG may be performed before cancer treatment to identify any pre-existing conditions, or during treatment to check for possible heart damage	CXR and CT scan: Mass lesion, hilar lymphadenopathy Spirometry: ↓Vt, ↑RV Bronchoscopy: Biopsy	Bronchoscopy
	Sarcoidosis^[105]^[106]^[107]^[108]	Chronic	Days to week	Chest fullness	+	-	+	+	Löfgren syndrome (fever, bilateral hilar lymphadenopathy (BHL), and polyarthralgias) Uveitis Heart block Lymphocytic meningitis Diabetes insipidus Fatigue Hypercalciuria	Black population Autoimmune diseases	Diminished respiratory sounds	↑ ACE level, adenosine deaminase, SAA, sIL2R Hypercalciuria Elevated 1,25-dihydroxyvitamin D levels	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	Chest radiograph: Bilateral hilar adenopathy High-resolution CT (HRCT) scanning of the chest: Ground glass opacification, Hilar and mediastinal lymphadenopathy, Bronchial wall thickening	Lung Biopsy
	Acute chest syndrome (Sickle cell anemia)^[109]^[110]^[111]	Acute	May last minutes to hours	Chest tightness	+	+/-	+	-	Sickle cell anemia Vaso-occlusive crisis Pain crises	↑ WBC ↑ Hb levels ↓ fetal hemoglobin levels Smoking Vaso-occlusive pain events	Systolic murmur may be heard over the entire precordium	↑Erythrocyte sedimentation rate Peripheral blood smears: Schistiocytes ↑ Reticulocyte count	EKG typically not indicated	Plain radiography of the extremities: Avascular necrosis	---
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	Risk Factors	Physical Exam	Lab Findings	EKG	Imaging	Gold Standard
Gastrointestinal	GERD, Peptic Ulcer^[112]^[113]^[114]	Acute	Minutes to hours (gastroesophageal reflux) Prolonged (peptic ulcer) 5 to 60 minutes	Burning Substernal Epigastric	+/-	-	-	+/-	Visceral, substernal, worse with recumbency, no radiation, relief with food, antacids Hematemesis or melena resulting from gastrointestinal bleeding Dyspepsia	Prolonged NSAIDs intake Smoking Alcohol abuse Spicy foods H-pylori infection	Not any auscultatory findings associated with this disease Enamel erosion or other dental manifestations	↑Serum Gastrin Level Secretin Stimulation Test H-Pylori testing	EKG usually normal but may show T wave inversions in leads V2 through V4 consistent with myocardial ischemia in patients with peptic ulcer perforation	Upper Gastrointestinal Endoscopy: Biopsy Esophageal Manometry: To exclude an esophageal motility disorder Esophageal impedance pH testing: Monitors esophageal pH	Upper Gastrointestinal Endoscopy
	Diffuse Esophageal Spasm^[115]^[116]^[117]^[118]	Acute	Minutes to hours 5 to 60 minutes	Burning Pressure Visceral, spontaneous, substernal	+	-	+/-	+/-	Associated with cold liquids Relief with nitroglycerin	---	---	Barium swallow: Multiple areas of spasm throughout the length of the esophagus Impedance testing: Higher amplitudes and better transit of swallowed boluses	No ECG findings associated with DES, but ECG is done to exclude variant angina due to higher concurrent association of variant angina with DES	Esophageal manometry : ≥20 percent premature contractions (distal latency <4.5 seconds)	Esophageal manometry
	Esophagitis^[119]^[120]^[121]	Acute	Variable	Burning Epigastric	+	+	-	+/-	Heartburn Abdominal pain	HIV Immunosuppression	No auscultatory finding	Troponin or other cardiac markers Leukopenia ↓CD4 count Human immunodeficiency virus (HIV) test	ECG is done to rule out acute coronary syndrome	Double-contrast esophageal barium study (esophagography) Endoscopy: Biopsy	Endoscopy
	Eosinophilic Esophagitis^[122]^[123]^[124]^[125]^[126]^[127]	Chronic	Variable	Burning Retrosternal Abdominal	+	-	-	-	Dysphagia Food impaction GERD	Allergic diseases Asthma Rinitis Eczema	No auscultatory finding in the this disease	Elevated IgE (>114,000 units/L) Elevated peripheral eosinophils	Typically no finding on EKG	Barium studies: Strictures and a ringed esophagus Endoscopy: Stacked circular rings ("feline" esophagus) ●Strictures ●Linear furrows ●Whitish papules Esophageal biopsy: More than 15 eosinophils per high-power field	Esophageal biopsy
	Esophageal Perforation^[17]	Acute	Minutes to hours	Burning Upper abdominal	-	+/-	+	-	Eating disorders such as bulimia Repeated episodes of retching and vomiting with either recent excessive dietary or alcohol intake Subcutaneous emphysema	Instrumentation/surgery Penetrating or blunt trauma Medications, other ingestions, foreign body Violent retching/vomiting Hernia/intestinal volvulus/obstruction Inflammatory bowel disease Appendicitis Peptic ulcer disease	Mild tachycardia or hypothermia Hamman crunch (crackling sound upon chest auscultation occurs due to pneumomediastinum)	↑Serum amylase ↑C-reactive protein levels	EKG may be indicated to assess for myocardial ischemia due to acute gastrointestinal bleeding, especially if there is coexisting:Cardiovascular disease, significant anemia and advanced age	Plain chest films or chest CT: Pneumomediastinum, Free air under the diaphragm, •Pleural effusion •Pneumothorax (Macklin effect). •Subcutaneous emphysema Plain abdominal films (or abdominal CT scout film):The appearance of pneumoperitoneum -Free air under the diaphragm -Cupola sign (inverted cup) -Rigler sign (double-wall sign) -Psoas sign -Urachus sign	Confirmed by water-soluble contrast esophagram
	Mediastinitis^[128]^[129]^[130]^[131]	Acute, Chronic	Variable	Retrosternal irritation	+/-	+	+	-	Nonspecific	Infection Esophageal perforation Post operative complication	Dysphagia Dysphonia Stridor Hamman sign	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
	Cholelithiasis^[132]^[133]^[134]^[135]	Acute, subacute	Minutes to hours	Burning Colicky Right upper abdomen Substernal epigastric	-	+/-	-	-	Obesity Fertile females in 40's	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)	Murphy sign negative Jaundice	↑ALT ↑AST ↑Amylase levels ↑ALP	Typically not indicated	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
	Pancreatitis^[136]^[137]^[138]^[139]^[140]	Acute, Chronic	Variable	Epigastric Upper left side of the abdomen Pressure like	-	+	+	+/-	Primary cirrhosis Primary sclerosing cholangitis Cystic fibrosis Autoimmune diseases	Alcohol abuse Smoking Genetic predisposition	Tachypnea Hypoxemia Hypotension Cullen's sign Grey Turner sign	↑Amylase levels ↑Lipase levels ↑ALT ↑ALP Leukocytosis	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
	Sliding Hiatal Hernia^[141]^[142]^[143]	Acute	Variable	Epigastric Burning	+	-	+	-	Obstruction Cameron ulcers GERD Dysphagia	Trauma Iatrogenic Congenital malformation	Bowel sounds may be heard in the chest	Non specific	T wave inversion in anterior lead.	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	Upper endoscopy High resolution manometry (for smaller hernias)
Musculoskeletal	Costosternal syndromes (costochondritis)^[144]^[145]^[146]^[147]	Acute, subacute	Days to weeks	Pressure like on anterior part of chest wall	-	+	-	-	History of repeated minor trauma or unaccustomed activity (eg, painting, moving furniture)	Trauma	Pain by palpation of tender areas Maneuvers, such as the "crowing rooster" and horizontal arm flexion maneuver	Non specific	EKG is done to rule out other cardiovascular causes	CXR: To rule out fracture	Pain by palpation of tender areas
	Lower rib pain syndromes^[148]	Chronic	Variable	Aching Lower chest Upper abdomen	-	-	+	-	Common in women with a mean age in the mid-40s	---	Hooking maneuver Reproduces pain by pressing a tender spot on the costal margin	Non specific The workup is done for excluding cardiac disorders and other causes of chest pain	EKG is done to rule out other cardiovascular causes	CXR: To rule out fracture	---
	Sternalis syndrome	Chronic	Variable	Pressure like pain Over the body of sternum Sternalis muscle Left or middle side of the chest wall	-	-	-	-	Cardiac diseases	Daily activities Emotional distress Anxiety	Localized tenderness is found directly over the body of the sternum or overlying sternalis muscle	No specific diagnostic test for this disease The workup is done for excluding cardiac disorders and other causes of chest pain	EKG is done to rule out other cardiovascular causes	X-ray : To rule out fracture	Physical exam
	Tietze's syndrome^[149]	Acute	Weeks	Pressure like pain over Costosternal joint Sternoclavicular joint Costochondral joint Second and third ribs	-	-	-	-	Most often involve the areas of 2nd and 3rd ribs More common in young adults Sternocostoclavicular hyperostosis Ankylosing spondylitis	Upper respiratory infections Excessive coughing	Painful and localized swelling of the costosternal, sternoclavicular, or costochondral joints most often involving 2nd and 3rd ribs	No specific diagnostic test for this disease The workup is done for excluding cardiac disorders and other causes of chest pain	EKG is done to rule out other cardiovascular causes	X-ray: To rule out fracture	Tests are done to rule out other diseases
	Xiphoidalgia^[150]	Acute	Variable	Pressure like pain over Over the xiphoid process Sternum Xiphisternal joint	-	-	-	-	Symptoms are aggravated by twisting and bending movements	Cough Heavy work	Provocative test	No specific diagnostic test for this disease The workup is done for excluding cardiac disorders and other causes of chest pain	EKG is done to rule out other cardiovascular causes	X-ray: To rule out fracture	Tests are done to rule out other diseases
	Spontaneous sternoclavicular subluxation^[151]	Acute, Chronic	Variable	Aching pain over Sternoclavicular joint	-	-	-	-	More common in middle age women Occurs in dominant hands with repetitive tasks of heavy or moderate quality	Trauma	Palpation of tender areas	No specific diagnostic test for this disease The workup is done for excluding cardiac disorders and other causes of chest pain	EKG is done to rule out other cardiovascular causes	X-ray: Sclerosis of the medial clavicle	X-ray
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	Risk Factors	Physical Exam	Lab Findings	EKG	Imaging	Gold Standard
Rheumatic	Fibromyalgia^[152]^[153]^[154]	Chronic	Variable	Raynaud phenomenon (RP) Deep ache and burning pain on Shoulders Back of the Neck Chest Lower Back Elbows Hips Shin Knees	-	-	+	-	Somatization Depression IBS	---	Presence of tenderness in soft-tissue anatomic locations	Non specific Normal Blood and urine test (mandatory to rule out other diseases)	P-wave dispersions (Pd)	---	---
	Rheumatoid arthritis^[155]	Chronic	Years	Symmetrical joint pain in Wrist Fingers Knees Feet Ankles	-	+	-	+	Extra-articular involvement of other organ systems Carpal tunnel syndrome Tarsal tunnel syndrome	Old age Smoking Autoimmune conditions	Reduced grip strength Rheumatoid nodules	Positive Rheumatic Factor Anti-CCP body Synovial fluid analysis: WBC between 1500 and 25,000/cubicmm, low glucose, low C3 and C4 complement level. Thrombocytosis Anemia Mild leukocytosis	ECG is done rule out the heart failure as RA is one of the causes of heart failure	Plain film radiography: periarticular osteopenia, joint space narrowing, and bone erosions MRI: Bone erosions Ultrasonography: Degree of inflammation and the volume of inflamed tissue	---
	Ankylosing spondylitis^[156]^[157]^[158]^[159]	Chronic	Years	Intermittent pain in Spine joint Sacroiliac joint	-	-	-	-	Patients with HLA-27 variant Extra-articular joint involvements Restrictive pulmonary disease Acute coronary syndromes (ACS), strokes, venous thromboembolism, conduction abnormalities	Genetics (Monozygotic twins)	Tenderness of the SI Limited spinal ROM Schober test	↑ESR ↑CRP ↑ALP ↑IgA Antigen HLA-27 positive Negative Rheumatic Factor	ECG is done to rule out conductions defects and aortic insufficiency	Plain radiography: Erosions, ankylosis, changes in joint width, or sclerosis. Magnetic resonance imaging (MRI): Osteitis" or "bone marrow edema" (BME)	Plain films of the sacroiliac joints
	Psoriatic arthritis^[158]	Chronic	Years	Asymmetrical intermittent pain in Interphalangeal joints Nails Wrist Knees Ankles Lower Back	-	-	-	-	Psoriasis Enthesitis Tenosynovitis Dactylitis	Psoriasis HLA-B*27 positive	Dactylitis with sausage digits Onycholysis Pitting edema Ocular involvement	Non specific	Longer PR interval	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	X-ray
	Sternocostoclavicular hyperostosis (SAPHO syndrome)^[158]^[160]^[161]^[162]^[163]	Chronic	Years	Recurrent and multifocal pain in Sternoclavicular joint	-	+	-	-	Palmoplantar pustulosis (PPP)	Positive family history of: Spondyloarthritis IBD Psoriasis Rheumatoid arthritis Other autoimmune/autoinflammatory disease	Hyperostosis Osteitis Synovitis Pustular eruptions Inflammatory nodules or plaques	Serologic testing to exclude other diseases Non specific	ECG is done to rule out conductions defects and aortic insufficiency	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	Bone scan
	Systemic lupus erythematosus^[164] ^[165]^[166]	Chronic	Years	Skin Joints (fingers, wrist, knees) Kidneys SLE can affect any organ of the body	+/-	+	+	+	HLA-genetic mutations Female gender Being younger than 50	Autoimmune conditions Genetic predisposition Positive family history	Malar rash Photosensitive rash Discoid rash Arthritis of the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands Pleuro-pericardial friction rubs Systolic murmurs	Elevation of autoantibodies (ANA, anti-dsDNA, anti-SM, antiphospholipid) Complement levels decreased Anemia	Sinus tachycardia, ST segment changes, and ventricular conduction disturbances	Related to specific organ involvent	Anti-dsDNA antibody test
	Relapsing polychondritis^[167]	Chronic	Years	Intermittent pain in: Tissues that cover the end of the joints Cartilage of costal rib	+	+	+	+	Hodkin's lymphoma Myelodysplastic syndromes Gastrointestinal disorders Type 1 Diabetes mellitus Auricular chondritis	Autoimmune diseases	Physical examinations findings are seen related to nasal chondritis, ocular inflammation, cardiovascular disease, skin disease, CNS and pulmonary system	Negative rheumatoid factor Anti-type II collagen antibodies Antineutrophil cytoplasmic antibodies	ECG is done to rule out the cardiovascular complications of this disease	Non specific Related to specific organ involvent	No gold standard test for this disease
Psychiatric	Panic attack/ Disorder^[168]^[18]^[169]	Acute or subacute or chronic	Variable	Variable	+	-	+	-	History of Depression Panic attacks Agoraphobia	Psychiatric disorders	Anxious Tachypneic	Thyroid function tests Complete blood count Chemistry panel	Sinus Tachycardia	No any specific radiographic test is done	---
Others	Substance abuse (Cocaine)^[170]^[171]^[172]	Acute (hours)	Minutes to hours	Pressure like pain in the center of chest	+	+	+	+	Anxiety Dyspnea Nausea Palpitations	Psychiatric disorders	Signs of injection drug use Signs of drug inhalation Poor personal hygiene	Serum biomarkers (Troponin I, Troponin T) Toxicologic tests or drug screens of bodily fluids (blood, urine, saliva) and hairs	QT prolongation Sinus Tachycardia Arrhythmias Cardiac conduction abnormalities	---	Gold standard test depends on the type of substance is abuse
Others	Herpes Zoster^[173]^[174]^[175]	Acute or Chronic	Variable	Burning pain on Chest Upper back Lower back	-	+	-	-	People who had chickenpox	Immunosuppression	Painful grouped herpetiform vesicles on an erythematous base distributed in a single dermatome	Viral culture Direct immunofluorescence testing, Polymerase chain reaction assay (PCR)	ECG is done to rule out other cardiovascular causes of chest pain	Magnetic resonance imaging (MRI): To rule out encephalitis	Viral tissue culture

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@@ Line 2: / Line 2: @@
 {{CMG}}, {{AE}} {{IQ}} {{AMK}}
-{{Chest pain}}
+[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Unstable_angina_/_non_ST_elevation_myocardial_infarction]]
-'''An expert algorithm to assist in the diagnosis of Chest pain can be found [[Diagnosis WikiDoc:Chest Pain|here]]'''
+'''An expert algorithm to assist in the diagnosis of Chest pain can be found [[Diagnosis WikiDoc:Chest Pain|here]].'''
-'''To go back to the main page on Unstable angina, click [[Unstable angina|here]]'''
+'''To go back to the main page on Unstable angina, click [[Unstable angina|here]].'''
 ==Overview==
-There are several life-threatening causes of chest pain which need to be evaluated for first, which include; [[myocardial infarction]], [[aortic dissection]], [[esophageal rupture]], [[pulmonary embolism]], and [[tension pneumothorax]]. The other possible causes of chest pain can be evaluated for by carefully assessing the nature of the pain, and obtaining a thorough patient history.
+There are several life-threatening causes of chest pain which need to be evaluated for first, which include; [[myocardial infarction]], [[aortic dissection]], [[esophageal rupture]], [[pulmonary embolism]], and [[tension pneumothorax]]. The other possible causes of chest pain can be determined by carefully assessing the nature of the pain, and obtaining a thorough patient history.
-==Differential Diagnosis==
+== 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines<ref name="pmid347098792">{{cite journal| author=Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK | display-authors=etal| title=2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2021 | volume= 144 | issue= 22 | pages= e368-e454 | pmid=34709879 | doi=10.1161/CIR.0000000000001029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34709879  }}</ref> ==
+=== '''Recommendation for Evaluation of Acute Chest Pain With Suspected Noncardiac Causes''' ===
+{| class="wikitable"
+|+
+| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme|Class I]]
+|-
+| bgcolor="LightGreen" |"'''1.''' Patients with acute chest pain should be evaluated for noncardiac causes if they have persistent or recurring symptoms despite a negative stress
+test or anatomic cardiac evaluation, or a low-risk designation by a CDP. (Level of Evidence: C-EO)"
+|}
+==Differential Diagnosis of Chest Pain==
 ===5 Life Threatening Diseases to Exclude Immediately===
 * [[Aortic dissection]]
@@ Line 21: / Line 32: @@
 The frequency of conditions exclusive of acute myocardial infarction in a decreasing order is:<ref name="pmid8809520">{{cite journal |author=Fruergaard P, Launbjerg J, Hesse B, Jørgensen F, Petri A, Eiken P, Aggestrup S, Elsborg L, Mellemgaard K |title=The diagnoses of patients admitted with acute chest pain but without myocardial infarction |journal=[[European Heart Journal]] |volume=17 |issue=7 |pages=1028–34 |year=1996 |month=July |pmid=8809520 |doi= |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=8809520 |accessdate=2012-05-02}}</ref>
 *Gastroesophageal disease
-*[[Ischemic heart disease]] (angina, not myocardial infarction)
+*[[Ischemic heart disease]] (angina)
 *Chest wall syndromes
+{| class="wikitable" style="margin: 1em auto 1em auto"
+!Differential Diagnosis of Non-Cardiac [[Chest pain]]
+|-
+|Respiratory
+*[[Pulmonary embolism]]
+* [[Pneumothorax]]
+* [[Hemothorax]]
+*[[Pneumomediastinum]]
+*[[Pneumonia]]
+*[[Bronchitis]]
+*[[Pleural irritation]]
+*[[Malignancy]]
+*
+|-
+|[[Gastrointestinal]]
+*[[Cholecystitis]]
+* [[Pancreatitis]]
+*[[Hiatal hernia]]
+*[[Gastroesophageal reflux disease]], [[gastritis]], [[esophagitis]]
+* [[Peptic ulcer disease]]
+* [[Esophageal spasm]]
+* [[Dyspepsia]]
+|-
+|[[Chest wall]]
+*[[Costochondritis]]
+*[[Chest wall trauma]], [[inflammation]]
+*[[Herpes Zoster]] ([[shingles]]
+*[[Cervical radiculopathy]]
+*[[Breast disease]]
+*[[Rib fracture]]
+*[[Musculoskeletal injury]], [[spasm]]
+|-
+|[[Psychological]]
+* [[Panic disorder]]
+*[[Anxiety]]
+*Clinical [[depression]]
+*[[Somatization disorder]]
+*[[Hypochondria]]
+|-
+|[[Other]]
+*[[Hyperventilation syndrome]]
+*[[Carbon monoxide poisoning]]
+*[[Sarcoidosis]]
+*[[Lead]] poisoning
+*[[Prolapsed intervertebral disc]]
+*[[Thoracic outlet syndrome]]
+*Side effect of medications ([[5-fluorouracil]])
+*[[Sickle cell crisis]]
+|-
+|}
+{|
+! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2021 AHA/ACC/ASE Guideline<ref name="pmid34709879">{{cite journal |vauthors=Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ |title=2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=144 |issue=22 |pages=e368–e454 |date=November 2021 |pmid=34709879 |doi=10.1161/CIR.0000000000001029 |url=}}</ref>
+|-
+|}
+===Differentiating the Life-Threatening and Ischemic Causes of Chest Pain from other Disorders===
+To review the differential diagnosis of chest pain, click '''''[[Chest pain differential diagnosis#Chest Pain|here]]'''.''
+To review the differential diagnosis of chest pain and cough, click '''''[[Chest pain and cough|here]]'''.''
+To review the differential diagnosis of chest pain and fever, click '''''[[Chest pain and fever|here]]'''.''
+To review the differential diagnosis of chest pain and dyspnea, click '''''[[Chest pain and dyspnea|here]]'''.''
+To review the differential diagnosis of chest pain and weight loss, click '''''[[Chest pain and weight loss|here]]'''.''
+To review the differential diagnosis of chest pain, cough, and fever, click '''''[[Chest pain, cough and fever|here]]'''.''
+To review the differential diagnosis of chest pain, cough, and dyspnea, click '''''[[Chest pain, cough and dyspnea|here]]'''.''
-===Differentiating the Life Threatening and Ischemic Causes of Chest Pain from other Disorders===
+To review the differential diagnosis of chest pain, cough, and weight loss, click '''''[[Chest pain, cough and weight loss|here]]'''.''
-Thorough history including: onset, duration, type of pain, location, exacerbating factors, alleviating factors, and radiation. Risk factors for coronary artery disease: [[family history]], [[smoking]], [[hyperlipidemia]], and [[diabetes]].
-===Differential Diagnosis of Chest Pain===
+To review the differential diagnosis of chest pain, fever, and dyspnea, click '''''[[Chest pain, fever and dyspnea|here]]'''.''
-{|
+To review the differential diagnosis of chest pain, fever, and weight loss, click '''''[[Chest pain, fever and weight loss|here]]'''.''
+To review the differential diagnosis of chest pain, dyspnea, and weight loss, click '''''[[Chest pain, dyspnea and weight loss|here]]'''.''<br>
+'''The following table outlines the major differential diagnoses of chest pain:'''<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. 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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. Clin. North Am. |volume=94 |issue=2 |pages=349–74 |date=March 2010 |pmid=20380960 |doi=10.1016/j.mcna.2010.01.011 |url=}}</ref><ref name="pmid15956000">{{cite journal |vauthors=Wang WH, Huang JQ, Zheng GF, Wong WM, Lam SK, Karlberg J, Xia HH, Fass R, Wong BC |title=Is proton pump inhibitor testing an effective approach to diagnose gastroesophageal reflux disease in patients with noncardiac chest pain?: a meta-analysis |journal=Arch. Intern. Med. |volume=165 |issue=11 |pages=1222–8 |date=June 2005 |pmid=15956000 |doi=10.1001/archinte.165.11.1222 |url=}}</ref><ref name="pmid10737285">{{cite journal |vauthors=Borzecki AM, Pedrosa MC, Prashker MJ |title=Should noncardiac chest pain be treated empirically? A cost-effectiveness analysis |journal=Arch. Intern. 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'''
+<small><small>
+{|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! rowspan="3" |Differentials on the basis of Etiology
+! rowspan="3" |Differentials on the Basis of Etiology
 ! rowspan="3" |Disease
-! colspan="9" |Clinical manifestations
+! colspan="10" |Clinical Manifestations
 ! colspan="4" |Diagnosis
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! colspan="8" |Symptoms
-! rowspan="2" |Physical exam
+! rowspan="2" |Risk Factors
-! rowspan="2" |Lab Findings
+! rowspan="2" |Physical Exam
+! rowspan="2" |Lab Findings
 ! rowspan="2" |EKG
 ! rowspan="2" |Imaging
-! rowspan="2" |Gold standard
+! rowspan="2" |Gold Standard
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 !Onset
 !Duration
-!Type of Pain
+!Quality of Pain
 !Cough
 !Fever
 !Dyspnea
-!Weight loss
+!Weight Loss
 !Associated Features
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-! rowspan="9" |Cardiac
+|
-!'''[[Stable Angina]]'''
+!'''[[Stable Angina]]'''<ref name="pmid23166211">{{cite journal |vauthors=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL |title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=126 |issue=25 |pages=e354–471 |date=December 2012 |pmid=23166211 |doi=10.1161/CIR.0b013e318277d6a0 |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |Sudden (acute)
 | style="background: #F5F5F5; padding: 5px;" |2-10 minutes
 | style="background: #F5F5F5; padding: 5px;" |
 *Heaviness/pressure/ tightness/squeezing/ burning ([[Levine's sign]])
-*Retrosternal  or left sided chest pain
+*[[Retrosternal]]  or left sided chest pain
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | -
@@ Line 66: / Line 158: @@
 *[[Nausea and vomiting|Nausea]] and [[vomiting]]
 *[[Diaphoresis]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Dyslipidemia]], [[hypertension]], smoking,  family history of premature disease, and [[diabetes]]
+| style="background: #F5F5F5; padding: 5px;" |
+*Transient [[third heart sound]] [[S3|(S3]] - [[Ventricular|ventricular filling sound]]) and [[fourth heart sound]] ([[S4]] - [[atrial]] filling sound)
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Cardiac enzymes]] normal
+| style="background: #F5F5F5; padding: 5px;" |
+*Exercise EKG: ST-segment depression
+| style="background: #F5F5F5; padding: 5px;" |
+*Exercise Stress Testing: Decreased [[myocardial]] perfusion
+*[[Transthoracic echocardiography]]: [[Ejection fraction]] <50 percent
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Coronary angiography]]
+|- style="background: #DCDCDC; padding: 5px;" |
+|
+!'''[[COVID-19-associated myocardial infarction]]'''<ref name="StefaniniMontorfano2020">{{cite journal|last1=Stefanini|first1=Giulio G.|last2=Montorfano|first2=Matteo|last3=Trabattoni|first3=Daniela|last4=Andreini|first4=Daniele|last5=Ferrante|first5=Giuseppe|last6=Ancona|first6=Marco|last7=Metra|first7=Marco|last8=Curello|first8=Salvatore|last9=Maffeo|first9=Diego|last10=Pero|first10=Gaetano|last11=Cacucci|first11=Michele|last12=Assanelli|first12=Emilio|last13=Bellini|first13=Barbara|last14=Russo|first14=Filippo|last15=Ielasi|first15=Alfonso|last16=Tespili|first16=Maurizio|last17=Danzi|first17=Gian Battista|last18=Vandoni|first18=Pietro|last19=Bollati|first19=Mario|last20=Barbieri|first20=Lucia|last21=Oreglia|first21=Jacopo|last22=Lettieri|first22=Corrado|last23=Cremonesi|first23=Alberto|last24=Carugo|first24=Stefano|last25=Reimers|first25=Bernhard|last26=Condorelli|first26=Gianluigi|last27=Chieffo|first27=Alaide|title=ST-Elevation Myocardial Infarction in Patients With COVID-19|journal=Circulation|volume=141|issue=25|year=2020|pages=2113–2116|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.120.047525}}</ref>
+| style="background: #F5F5F5; padding: 5px;" |Sudden (acute)
+| style="background: #F5F5F5; padding: 5px;" |Commonly > 20 minutes
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Retrosternal]]  or left sided chest pain
+*Same as stable angina but often more severe
+| 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;" |
+*[[Nausea and vomiting|Nausea]] and [[vomiting]]
+*[[Diaphoresis]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Dyslipidemia]], [[hypertension]], smoking,  family history of premature disease, and [[diabetes]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Transient [[third heart sound]] [[S3|(S3]] - [[Ventricular|ventricular filling sound]]) and [[fourth heart sound]] ([[S4]] - [[atrial]] filling sound)
 | style="background: #F5F5F5; padding: 5px;" |
-*Cardiac enzymes normal
+*[[Cardiac enzymes]] elevated
 | style="background: #F5F5F5; padding: 5px;" |
-*Exercise EKG test shows  ST-segment depression
+*ST elevation MI (STEMI)
+*Non-ST elevation MI (NSTEMI) or Non Q wave
 | style="background: #F5F5F5; padding: 5px;" |
-*Exercise Stress Testing
+*Exercise Stress Testing: Decreased [[myocardial]] perfusion
-*Stress Echocardiography
+*[[Transthoracic echocardiography]]:
+**Localized wall motion abnormalities
+**Diffuse hypokinesia
+**Left ventricular ejection fraction was lower than 50% in about 61% of the individuals
 | style="background: #F5F5F5; padding: 5px;" |
-*Coronary angiography
+*[[Coronary angiography]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Unstable Angina]]'''
+|
-| style="background: #F5F5F5; padding: 5px;" |Acute
+!'''[[Unstable Angina]]'''<ref name="pmid8998090">{{cite journal |vauthors=Tatum JL, Jesse RL, Kontos MC, Nicholson CS, Schmidt KL, Roberts CS, Ornato JP |title=Comprehensive strategy for the evaluation and triage of the chest pain patient |journal=Ann Emerg Med |volume=29 |issue=1 |pages=116–25 |date=January 1997 |pmid=8998090 |doi= |url=}}</ref><ref name="pmid10492848">{{cite journal |vauthors=Ornato JP |title=Chest pain emergency centers: improving acute myocardial infarction care |journal=Clin Cardiol |volume=22 |issue=8 Suppl |pages=IV3–9 |date=August 1999 |pmid=10492848 |doi= |url=}}</ref><ref name="pmid7611601">{{cite journal |vauthors=Gibler WB |title=Evaluation of chest pain in the emergency department |journal=Ann. Intern. Med. |volume=123 |issue=4 |pages=315; author reply 317–8 |date=August 1995 |pmid=7611601 |doi= |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
 | style="background: #F5F5F5; padding: 5px;" |10-20 minutes
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 92: / Line 219: @@
 *[[Presyncope]]
 *[[Palpitation|Palpitations]]
-*[[Elevated jugular venous pressure]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Dyslipidemia]], [[hypertension]], smoking,  family history of premature disease, and [[diabetes]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Reverse [[Splitting of S2|splitting]] of the [[second heart sound]]
 *[[Rales/Crackles|Rales or crackles]]
+*[[Elevated jugular venous pressure]]
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Cardiac Biomarkers|Cardiac biomarkers [Cardiac troponin I, cardiac troponin T]] and [[CK MB|<nowiki>MB isoenzyme of creatine kinase (CK-MB)]</nowiki>]] normal
 | style="background: #F5F5F5; padding: 5px;" |
-*ST-depression
+*[[ST-depression]]
-*T wave inversions
+*New [[T wave]] inversions
-*Transient ST-elevation
+*Transient [[ST-elevation]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Echocardiography
+*[[Echocardiography]]: [[Ejection fraction]] <50 percent
-*SPECT and MRI
+*Exercise Stress Testing: Decreased [[myocardial]] perfusion
-*Myocardial Perfusion Imaging
-*Exercise Testing
 | style="background: #F5F5F5; padding: 5px;" |
-*Invasive coronary angiography
+*Invasive [[coronary angiography]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Myocardial Infarction]]'''
+|
-| style="background: #F5F5F5; padding: 5px;" |Acute
+!'''[[Myocardial Infarction]]'''<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>
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
 | style="background: #F5F5F5; padding: 5px;" |Commonly > 20 minutes
 | style="background: #F5F5F5; padding: 5px;" |
-*Same as stable angina but often more severe
+*Same as [[stable angina]] but often more severe
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | -
@@ Line 126: / Line 254: @@
 *[[Lateral]] [[displacement]] of the [[apical impulse]]
 | style="background: #F5F5F5; padding: 5px;" |
+*[[Dyslipidemia]], [[hypertension]], smoking,  family history of premature disease, and [[diabetes]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Hypotension]]
+*[[Tachycardia]]
 *[[S4]] [[Gallop rhythm|gallop]]
 *[[Paradoxical splitting of S2]]
@@ Line 134: / Line 266: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *ST elevation MI (STEMI)
-*Non-ST elevation MI (NSTEMI) or Non Q wave
+*Non-ST elevation MI (NSTEMI) or Non [[Q wave]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Echocardiography
+*[[Echocardiography]]: ↓ EF
-*Coronary angiography
+*CCTA: [[Coronory artery]] stenosis
-*Multidetector computed tomography (MDCT) coronary angiography
+*CMRI: Coronory vessels [[stenosis]]
-*Myocardial perfusion imaging (MPI) with single-photon emission CT (SPECT) or positron emission tomography (PET) scanning
+*MPI on SPECT or PET scanning: Decreased [[myocardial]] perfusion.
 | style="background: #F5F5F5; padding: 5px;" |
-*Elevated cardiac biomarkers [Cardiac troponin I, cardiac troponin T)
+*CCTA combined with MPI
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Aortic Stenosis]]'''
+! rowspan="9" |Cardiac
-| style="background: #F5F5F5; padding: 5px;" |Acute, recurrent episodes of angina
+![[Prinzmetal's angina|Vasospastic/ Prinzmetal/ Variant Angina]]<ref name="pmid14434946">{{cite journal |vauthors=PRINZMETAL M, KENNAMER R, MERLISS R, WADA T, BOR N |title=Angina pectoris. I. A variant form of angina pectoris; preliminary report |journal=Am. J. Med. |volume=27 |issue= |pages=375–88 |date=September 1959 |pmid=14434946 |doi= |url=}}</ref><ref name="pmid3779913">{{cite journal |vauthors=Kaski JC, Crea F, Meran D, Rodriguez L, Araujo L, Chierchia S, Davies G, Maseri A |title=Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina |journal=Circulation |volume=74 |issue=6 |pages=1255–65 |date=December 1986 |pmid=3779913 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |2-10 minutes
+| style="background: #F5F5F5; padding: 5px;" |Gradual in onset and offset
+| style="background: #F5F5F5; padding: 5px;" |Episodic, gradual in onset and offset
 | style="background: #F5F5F5; padding: 5px;" |
-*Heaviness/pressure/ tightness/squeezing/ burning ([[Levine's sign]])
+*Chest discomfort described as squeezing, tightness, pressure, constriction, strangling, burning, heart burn, fullness in the chest, a band-like sensation, knot in the center of the chest, lump in the throat, ache, and heavy weight on chest
-*Retrosternal
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | -
@@ Line 154: / Line 286: @@
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Dyspnea]] and decreased exercise tolerance
+* [[Nausea]], [[diaphoresis]], [[dizziness]], [[dyspnea]], and [[palpitations]]
-*[[Dizziness]] and [[syncope]]
+* Associated with other vasospastic disorders, such as [[Raynaud's phenomenon]] and [[migraine]] [[headache]]
-*[[Angina pectoris]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Multiple drugs (ephedrine-based products, [[cocaine]], [[marijuana]], alcohol, butane, sumatriptan, and amphetamines)
+* Food-born [[botulism]]
+* Guide wire or balloon dilatation while doing PCI
+* [[Magnesium]] deficiency
 | style="background: #F5F5F5; padding: 5px;" |
-*[[S2]] is soft, single and [[Paradoxical splitting of S2|paradoxically split]]
+*[[Tachycardia]], [[hypertension]], [[diaphoresis]], and a gallop rhythm
-*[[A2]] delayed and tends to occur simultaneously with [[P2]]
-*[[Aortic]] [[Ejection murmur|ejection]] click
-*[[Fourth heart sound|Fourth heart sound (S4)]] can also be heard
-*Crescendo–decrescendo [[Heart murmur|murmur]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Peripheral blood smear may show schistiocytes
+* Urine drug screen may be positive for [[cocaine]] or other drugs
 | style="background: #F5F5F5; padding: 5px;" |
-*Non specific (the voltage of the QRS complex is increased showing the presence of left ventricular hypertrophy)
+* Transient (less than 15 minutes) ischemic ST changes in multiple leads
+* A tall and broad [[R wave]],
+* Disappearance of the [[S wave]]
+* A taller T wave
+* Negative [[U waves]]
 | style="background: #F5F5F5; padding: 5px;" |
-*CXR
+* Stress testing: normal noninvasive stress test, exercise-induced spasm with ST-segment elevation,
-*Echocardiography
+* [[Stress echocardiography]] with ergonovine provocation: [[Vasospasm]] of [[coronory vessels]]
-*Cardiac Catheterization and Coronary Arteriography
+* Coronary arteriography: [[Epicardial]] spasm
-*Radionuclide Ventriculography
 | style="background: #F5F5F5; padding: 5px;" |
-**Transthoracic Echo
+* [[Coronary arteriography]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Aortic Dissection]]'''
+!'''[[Aortic Dissection]]'''<ref name="pmid28847596">{{cite journal |vauthors=Takagi H, Ando T, Umemoto T |title=Meta-Analysis of Circadian Variation in the Onset of Acute Aortic Dissection |journal=Am. J. Cardiol. |volume=120 |issue=9 |pages=1662–1666 |date=November 2017 |pmid=28847596 |doi=10.1016/j.amjcard.2017.07.067 |url=}}</ref><ref name="pmid11922269">{{cite journal |vauthors=Kojima S, Sumiyoshi M, Nakata Y, Daida H |title=Triggers and circadian distribution of the onset of acute aortic dissection |journal=Circ. J. |volume=66 |issue=3 |pages=232–5 |date=March 2002 |pmid=11922269 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Sudden severe progressive pain (common) or chronic (rare)
+| style="background: #F5F5F5; padding: 5px;" |Sudden severe progressive pain (common) or [[chronic]] (rare)
 | style="background: #F5F5F5; padding: 5px;" |Variable
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 187: / Line 322: @@
 *[[Focal neurologic deficit]]
 *[[Hypotension]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Hypertension]]
+* Genetically mediated [[collagen disorders]]
+* Preexisting [[aortic aneurysm]]
+* [[Bicuspid aortic valve]]
+* [[Aortic coarctation]]
+* [[Turner syndrome]]
+* [[Vasculitis]] ([[giant cell arteritis]], [[Takayasu arteritis]], [[rheumatoid arthritis]], [[syphilitic aortitis]])
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Pulse]] deficit
 *New [[Diastolic murmurs|diastolic murmur]]
 *[[Diastolic]] decrescendo [[Heart murmur|murmur]]
+*[[Focal neurologic deficit]]
+*[[Hypotension]]
 | style="background: #F5F5F5; padding: 5px;" |
-* [[D-dimer]] <500 ng/mL rules out aortic dissection
+* [[D-dimer]] <500 ng/mL rules out [[aortic dissection]]
-* Measurements of soluble elastin fragments, smooth muscle myosin heavy chain, high-sensitivity [[C-reactive protein (CRP)|C-reactive protein]], [[fibrinogen]], and [[Fibrillin|fibrillin fragments]]
+* ↑Soluble ST2 (sST2)
+* Measurements of soluble elastin fragments, smooth muscle [[myosin heavy chain]], high-sensitivity [[C-reactive protein (CRP)|C-reactive protein]], [[fibrinogen]], and [[Fibrillin|fibrillin fragments]]
 | style="background: #F5F5F5; padding: 5px;" |
 * Nonspecific ST and T wave changes
 | style="background: #F5F5F5; padding: 5px;" |
-*CXR: Mediastinal and/or aortic widening
+*CXR: [[Mediastinal]] and/or [[aortic widening]]
-*CTA
+*CTA: A compressed [[true lumen]]
-*MRA
+*MRA: Detects differential flow between the true and false lumens, widening of the [[aorta]] with a thickened wall
-*TEE
+*TEE: [[Intimal]] [[dissection]] flaps, true and false lumens, [[thrombosis]] in the false lumen
+*[[Aortography]]: Distortion of the normal contrast column, Flow reversal or stasis into a false channel, Failure of major branches to fill, and [[Aortic]] [[valvular regurgitation]]
 | style="background: #F5F5F5; padding: 5px;" |
-*MRI
+*[[CT angiography]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+*[[Digital subtraction aortography]] (if high suspicion)
-|'''[[Pericarditis]]'''
+|- style="background: #DCDCDC; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute
+!'''[[Pericarditis]]'''<ref name="pmid15028364">{{cite journal |vauthors=Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R |title=Day-hospital treatment of acute pericarditis: a management program for outpatient therapy |journal=J. Am. Coll. Cardiol. |volume=43 |issue=6 |pages=1042–6 |date=March 2004 |pmid=15028364 |doi=10.1016/j.jacc.2003.09.055 |url=}}</ref><ref name="pmid15001332">{{cite journal |vauthors=Troughton RW, Asher CR, Klein AL |title=Pericarditis |journal=Lancet |volume=363 |issue=9410 |pages=717–27 |date=February 2004 |pmid=15001332 |doi=10.1016/S0140-6736(04)15648-1 |url=}}</ref><ref name="pmid12622586">{{cite journal |vauthors=Spodick DH |title=Acute pericarditis: current concepts and practice |journal=JAMA |volume=289 |issue=9 |pages=1150–3 |date=March 2003 |pmid=12622586 |doi= |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]]
 | style="background: #F5F5F5; padding: 5px;" |May last for hours to days
 | style="background: #F5F5F5; padding: 5px;" |
-*Sharp & localized retrosternal pain
+*Sharp & localized [[retrosternal]] pain
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 215: / Line 363: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Pericardial friction rub]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[HIV]]
+*[[TB]]
+*[[Immunosuppression]]
+*[[Acute]] trauma
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Pericardial friction rub]] heard with the [[diaphragm]] of [[stethoscope]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Leukocytosis
+*[[Leukocytosis]]
 *↑[[Cardiac troponin I (cTnI) and T (cTnT)|Troponin level]]
 *↑[[Erythrocyte sedimentation rate]]
 *↑[[C-reactive protein|C-reactive protein level]]
 | style="background: #F5F5F5; padding: 5px;" |
-*EKG changes (typically widespread ST segment elevation or PR depressions)
+*[[EKG]] changes (typically widespread [[ST segment]] elevation or [[PR depressions]])
 | style="background: #F5F5F5; padding: 5px;" |
-*Chest x-ray typically normal
+*[[Chest x-ray]] typically normal
-*Echocardiogram: normal or pericardial effusion
+*[[Echocardiogram]]: normal or [[pericardial effusion]]
-*CT scan: Noncalcified pericardial thickening with pericardial effusion
+*[[CT scan]]: Noncalcified [[pericardial]] thickening with [[pericardial effusion]]
-*CMR: inflamed pericardium and myocarditis
+*CMR: inflamed [[pericardium]] and [[myocarditis]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Pericardiocentesis
+*[[Pericardiocentesis]]
-*Pericardial biopsy
+*[[Pericardial biopsy]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Pericardial Tamponade]]
+![[Pericardial Tamponade]]<ref name="pmid20756103">{{cite journal |vauthors=Ewart W |title=Practical Aids in the Diagnosis of Pericardial Effusion, in Connection with the Question as to Surgical Treatment |journal=Br Med J |volume=1 |issue=1838 |pages=717–21 |date=March 1896 |pmid=20756103 |pmc=2406464 |doi= |url=}}</ref><ref name="pmid26320112">{{cite journal |vauthors=Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristić AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W, Achenbach S, Agewall S, Al-Attar N, Angel Ferrer J, Arad M, Asteggiano R, Bueno H, Caforio AL, Carerj S, Ceconi C, Evangelista A, Flachskampf F, Giannakoulas G, Gielen S, Habib G, Kolh P, Lambrinou E, Lancellotti P, Lazaros G, Linhart A, Meurin P, Nieman K, Piepoli MF, Price S, Roos-Hesselink J, Roubille F, Ruschitzka F, Sagristà Sauleda J, Sousa-Uva M, Uwe Voigt J, Luis Zamorano J |title=2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS) |journal=Eur. Heart J. |volume=36 |issue=42 |pages=2921–64 |date=November 2015 |pmid=26320112 |doi=10.1093/eurheartj/ehv318 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]]
 | style="background: #F5F5F5; padding: 5px;" |May last for hours to days
 | style="background: #F5F5F5; padding: 5px;" |
-*Sharp and stabbing retrosternal pain
+*Sharp and stabbing [[retrosternal]] pain
 | style="background: #F5F5F5; padding: 5px;" | +/-
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 245: / Line 398: @@
 *[[Pulsus paradoxus]]
 *[[Pericardial friction rub|Pericardial rub]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[HIV]]
+*[[TB]]
+*[[Immunosuppression]]
+*Acute trauma
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Kussmaul's sign|Kussmaul sign]]
@@ Line 255: / Line 413: @@
 *[[HIV testing]]
 | style="background: #F5F5F5; padding: 5px;" |EKG findings:
-* Sinus tachycardia
+*[[Sinus tachycardia]]
-* Low QRS voltage
+*Low QRS voltage
-* Electrical alternans
+*[[Electrical alternans]]
 | style="background: #F5F5F5; padding: 5px;" |
-*CXR: enlarged cardiac silhouette with clear lung fields
+*[[CXR]]: enlarged [[cardiac silhouette]] with clear lung fields
-*Echocardiography: Chamber collapse, Respiratory variation in volumes and flows, IVC plethora
+*[[Echocardiography]]: Chamber collapse, Respiratory variation in volumes and flows, [[IVC]] [[plethora]]
-*Swan-Ganz Catheterization: Equilibration of average intracardiac diastolic pressures (usually between 10 and 30 mmHg)
+*[[Swan-Ganz Catheterization]]: Equilibration of average [[intracardiac]] [[diastolic pressures]] (usually between 10 and 30 mmHg)
 | style="background: #F5F5F5; padding: 5px;" |
-*Echocardiography
+*[[Echocardiography]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Heart Failure]]
+![[Myocarditis]]<ref name="pmid3974674">{{cite journal |vauthors=Dec GW, Palacios IF, Fallon JT, Aretz HT, Mills J, Lee DC, Johnson RA |title=Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome |journal=N. Engl. J. Med. |volume=312 |issue=14 |pages=885–90 |date=April 1985 |pmid=3974674 |doi=10.1056/NEJM198504043121404 |url=}}</ref><ref name="pmid17493945">{{cite journal |vauthors=Caforio AL, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, Ramondo A, Carturan E, Iliceto S, Thiene G, Daliento L |title=A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis |journal=Eur. Heart J. |volume=28 |issue=11 |pages=1326–33 |date=June 2007 |pmid=17493945 |doi=10.1093/eurheartj/ehm076 |url=}}</ref><ref name="pmid21239404">{{cite journal |vauthors=Ukena C, Mahfoud F, Kindermann I, Kandolf R, Kindermann M, Böhm M |title=Prognostic electrocardiographic parameters in patients with suspected myocarditis |journal=Eur. J. Heart Fail. |volume=13 |issue=4 |pages=398–405 |date=April 2011 |pmid=21239404 |doi=10.1093/eurjhf/hfq229 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Subacute or chronic
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]]
 | style="background: #F5F5F5; padding: 5px;" |Variable
 | style="background: #F5F5F5; padding: 5px;" |
-*Dull
+* Sharp & localized [[retrosternal]] pain reflects associated [[pericarditis]]
-*Left sided chest pain
+| 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;" |
-*[[Orthopnea]]
+*[[Heart failure]]
-*[[Peripheral edema]]
+*[[Sudden cardiac death]]
-*[[Hemoptysis]]
+*[[Arrythmias]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Ischemic heart disease]]
+*[[Valvular heart disease]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[S3]] and [[S4]] gallop
+*[[Cardiac murmurs]]
+*[[Pericardial friction rub]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Serum [[cardiac troponin]] levels
+* ↑ [[BNP]] or NT-proBNP level
+| style="background: #F5F5F5; padding: 5px;" |
+*Nonspecific ST changes, single [[atrial]] or [[ventricular]] [[ectopic beats]], complex [[ventricular arrhythmias]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[CXR]]: Normal to enlarged with or without [[pulmonary]] [[vascular congestion]] and [[pleural effusions]]
+*[[Echo]]: Left [[ventricular]] dilation, changes in left [[ventricular]] geometry (eg, development of a more spheroid shape), and wall motion abnormalities
+* CMR: T1 and T2 signal intensity consistent with [[edema]], presence of LGE consistent with [[necrosis]] or [[scar]]
+* Radionuclide ventriculography: ↓ EF
+* [[Cardiac catheterization]]: Assessment of hemodynamic status
 | style="background: #F5F5F5; padding: 5px;" |
-*[[S3]]
+*[[Endomyocardial biopsy]]
-*[[Jugular venous pressure|Elevated JVP]]
+|- style="background: #DCDCDC; padding: 5px;" |
-*[[Peripheral edema]]
+![[Hypertrophic cardiomyopathy]]<ref name="pmid8809524">{{cite journal |vauthors=Elliott PM, Kaski JC, Prasad K, Seo H, Slade AK, Goldman JH, McKenna WJ |title=Chest pain during daily life in patients with hypertrophic cardiomyopathy: an ambulatory electrocardiographic study |journal=Eur. Heart J. |volume=17 |issue=7 |pages=1056–64 |date=July 1996 |pmid=8809524 |doi= |url=}}</ref><ref name="pmid7199403">{{cite journal |vauthors=Pasternac A, Noble J, Streulens Y, Elie R, Henschke C, Bourassa MG |title=Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries |journal=Circulation |volume=65 |issue=4 |pages=778–89 |date=April 1982 |pmid=7199403 |doi= |url=}}</ref><ref name="pmid2295747">{{cite journal |vauthors=Webb JG, Sasson Z, Rakowski H, Liu P, Wigle ED |title=Apical hypertrophic cardiomyopathy: clinical follow-up and diagnostic correlates |journal=J. Am. Coll. Cardiol. |volume=15 |issue=1 |pages=83–90 |date=January 1990 |pmid=2295747 |doi= |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]]
+| style="background: #F5F5F5; padding: 5px;" |Variable
+| style="background: #F5F5F5; padding: 5px;" |Typical or atypical chest pain
+| 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;" |
-*[[Thyroid function tests]] may be abnormal
+*[[HF]]
-*↑ [[Brain natriuretic peptide|Serum brain natriuretic peptide (BNP) or NT-proBNP level]]
+*[[Arrhythmias]]
+*[[Syncope]]
+*Acute hemodynamic collapse
 | style="background: #F5F5F5; padding: 5px;" |
-*EKG findings are specific according to each cause of heart failure
+* Positive family history of sudden cardiac death
+* [[Genetic mutation]]
 | style="background: #F5F5F5; padding: 5px;" |
-*CXR: Cardiomegaly
+* [[S4]]
-*Radionuclide multiple-gated acquisition scanning
+* [[Systolic murmurs]]
-*Electrocardiogram-gated myocardial perfusion imaging
+* LV apical impulse
-*Equilibrium radionuclide angiocardiography
+* Brisk [[carotid pulse]]
-*Catheterization and Angiography
+* ↑ [[JVP]]
+* A [[parasternal lift]]
+| style="background: #F5F5F5; padding: 5px;" |Non-specific
 | style="background: #F5F5F5; padding: 5px;" |
-*Echocardiography
+* Prominent abnormal [[Q waves]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+* [[P wave]] abnormalities
-|[[Stress cardiomyopathy|Stress (takotsubo)]]
+* [[Left axis deviation]]
-[[Stress cardiomyopathy|Cardiomyopathy]]
+* Deeply inverted [[T waves]]
-| style="background: #F5F5F5; padding: 5px;" |Acute
+| style="background: #F5F5F5; padding: 5px;" |
+[[Echocardiography]]:
+* [[LV hypertrophy]]
+* Systolic anterior motion of the [[mitral valve]],
+* [[LVOT obstruction]]
+*[[Cardiac catheterization]]
+**Pressure gradient
+**Augmentation of the gradient
+**[[Aortic pressure]]
+**[[Left ventricular]] pressure
+**Left [[atrial]] or [[pulmonary]] [[capillary wedge pressure]]
+*[[Coronary angiography]]
+**Obstructive [[epicardial]] [[coronary artery disease]]
+**[[Genetic testing]] for [[HCM]]: [[Sarcomere]] [[mutation]] in an athlete with a maximal LV wall thickness in the "grey zone"
+| style="background: #F5F5F5; padding: 5px;" |[[Genetic testing]] for HCM
+|- style="background: #DCDCDC; padding: 5px;" |
+![[Stress cardiomyopathy|Stress (takotsubo)]]
+[[Stress cardiomyopathy|Cardiomyopathy]]<ref name="pmid15687136">{{cite journal |vauthors=Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ |title=Acute and reversible cardiomyopathy provoked by stress in women from the United States |journal=Circulation |volume=111 |issue=4 |pages=472–9 |date=February 2005 |pmid=15687136 |doi=10.1161/01.CIR.0000153801.51470.EB |url=}}</ref><ref name="pmid26159108">{{cite journal |vauthors=Krishnamoorthy P, Garg J, Sharma A, Palaniswamy C, Shah N, Lanier G, Patel NC, Lavie CJ, Ahmad H |title=Gender Differences and Predictors of Mortality in Takotsubo Cardiomyopathy: Analysis from the National Inpatient Sample 2009-2010 Database |journal=Cardiology |volume=132 |issue=2 |pages=131–136 |date=July 2015 |pmid=26159108 |doi=10.1159/000430782 |url=}}</ref><ref name="pmid26332547">{{cite journal |vauthors=Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF |title=Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy |journal=N. Engl. J. Med. |volume=373 |issue=10 |pages=929–38 |date=September 2015 |pmid=26332547 |doi=10.1056/NEJMoa1406761 |url=}}</ref><ref name="pmid15583228">{{cite journal |vauthors=Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS |title=Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction |journal=Ann. Intern. Med. |volume=141 |issue=11 |pages=858–65 |date=December 2004 |pmid=15583228 |doi= |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
 | style="background: #F5F5F5; padding: 5px;" |Commonly > 20 minutes
 | style="background: #F5F5F5; padding: 5px;" |
-*Substernal heaviness or tightness
+*[[Substernal]] heaviness or tightness
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | -
@@ Line 309: / Line 516: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *Setting of physical or emotional stress or critical illness
+| style="background: #F5F5F5; padding: 5px;" |Stress
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Murmurs]] and [[rales]] may be present on [[auscultation]] in the setting of [[Pulmonary edema|acute pulmonary edema]]
@@ Line 316: / Line 524: @@
 *↑[[Brain natriuretic peptide|BNP level]]
 | style="background: #F5F5F5; padding: 5px;" |
-*ST segment elevation
+*[[ST segment elevation]]
-*ST depression
+*[[ST depression]]
-*QT interval prolongation, T wave inversion, abnormal Q waves
+*[[QT interval prolongation]], [[T wave inversion]], abnormal [[Q waves]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Radionuclide]] [[myocardial perfusion]] imaging: Transient perfusion abnormalities in the left ventricular apex
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Ventriculography]] and [[invasive coronary angiography]]
+|- style="background: #DCDCDC; padding: 5px;" |
+!'''[[Aortic Stenosis]]'''<ref name="pmid3984868">{{cite journal |vauthors=Green SJ, Pizzarello RA, Padmanabhan VT, Ong LY, Hall MH, Tortolani AJ |title=Relation of angina pectoris to coronary artery disease in aortic valve stenosis |journal=Am. J. Cardiol. |volume=55 |issue=8 |pages=1063–5 |date=April 1985 |pmid=3984868 |doi= |url=}}</ref><ref name="pmid16352020">{{cite journal |vauthors=Silaruks S, Clark D, Thinkhamrop B, Sia B, Buxton B, Tonkin A |title=Angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis |journal=Heart Lung Circ |volume=10 |issue=1 |pages=14–23 |date=2001 |pmid=16352020 |doi=10.1046/j.1444-2892.2001.00060.x |url=}}</ref><ref name="pmid9924164">{{cite journal |vauthors=Munt B, Legget ME, Kraft CD, Miyake-Hull CY, Fujioka M, Otto CM |title=Physical examination in valvular aortic stenosis: correlation with stenosis severity and prediction of clinical outcome |journal=Am. Heart J. |volume=137 |issue=2 |pages=298–306 |date=February 1999 |pmid=9924164 |doi=10.1053/hj.1999.v137.95496 |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]], recurrent episodes of [[angina]]
+| style="background: #F5F5F5; padding: 5px;" |2-10 minutes
+| style="background: #F5F5F5; padding: 5px;" |
+*Heaviness/pressure/ tightness/squeezing/ burning ([[Levine's sign]])
+*[[Retrosternal]]
+| 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]] and decreased exercise tolerance
+*[[Dizziness]] and [[syncope]]
+*[[Angina pectoris]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Radionuclide myocardial perfusion imaging
+*[[HTN]]
+* Old age
 | style="background: #F5F5F5; padding: 5px;" |
-*Ventriculography and invasive coronary angiography
+*[[S2]] is soft, single and [[Paradoxical splitting of S2|paradoxically split]]
+*[[A2]] delayed and tends to occur simultaneously with [[P2]]
+*[[Aortic]] [[Ejection murmur|ejection]] click
+*[[Fourth heart sound|Fourth heart sound (S4)]] can also be heard
+*Crescendo–decrescendo [[Heart murmur|murmur]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Schistiocytes]] on [[peripheral blood smear]]
+| style="background: #F5F5F5; padding: 5px;" |
+*Non specific (the voltage of the [[QRS complex]] is increased showing the presence of [[left ventricular hypertrophy]])
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Echocardiography]]: [[aortic leaflets]] thickened and calcified, ↑ [[pulmonary artery pressure]])
+*CMR: [[Myocardial fibrosis]], evaluation of [[aortic]] anatomy and size
+*MDCT: Degree of [[aortic valve]] calcification
+*PET: Measures active [[mineralization]] which correlates with [[stenosis]] severity
+| style="background: #F5F5F5; padding: 5px;" |
+**[[Echocardiography]]
+|- style="background: #DCDCDC; padding: 5px;" |
+![[Heart Failure]]<ref name="pmid12163209">{{cite journal |vauthors=Anker SD, Sharma R |title=The syndrome of cardiac cachexia |journal=Int. J. Cardiol. |volume=85 |issue=1 |pages=51–66 |date=September 2002 |pmid=12163209 |doi= |url=}}</ref><ref name="pmid18440336">{{cite journal |vauthors=Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarow GC |title=Albumin levels predict survival in patients with systolic heart failure |journal=Am. Heart J. |volume=155 |issue=5 |pages=883–9 |date=May 2008 |pmid=18440336 |doi=10.1016/j.ahj.2007.11.043 |url=}}</ref><ref name="pmid27656000">{{cite journal |vauthors=Breathett K, Allen LA, Udelson J, Davis G, Bristow M |title=Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced Ejection Fraction |journal=Circ Heart Fail |volume=9 |issue=10 |pages= |date=October 2016 |pmid=27656000 |pmc=5082710 |doi=10.1161/CIRCHEARTFAILURE.115.002962 |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px;" |[[Subacute]] or [[chronic]]
+| style="background: #F5F5F5; padding: 5px;" |Variable
+| style="background: #F5F5F5; padding: 5px;" |
+*Dull
+*Left sided chest pain
+| 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;" |
+*[[Orthopnea]]
+*[[Peripheral edema]]
+*[[Hemoptysis]]
+| style="background: #F5F5F5; padding: 5px;" |[[Dyslipidemia]], [[hypertension]], smoking,  family history of premature disease, and [[diabetes]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[S3]]
+*[[Jugular venous pressure|Elevated JVP]]
+*[[Peripheral edema]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Hyponatremia]]
+* [[Hypoalbuminemia]]
+* ↑ [[Brain natriuretic peptide|Serum brain natriuretic peptide (BNP) or NT-proBNP level]]
+* A mild elevation in serum [[bilirubin]] (total bilirubin <3 mg/dL)
+| style="background: #F5F5F5; padding: 5px;" |
+*EKG findings are specific according to each cause of [[heart failure]]
+*[[Q waves]], [[ST]] and [[T wave]] abnormalities in patients with prior MI
+*New onset [[arrhythmias]] ([[atrial fibrillation]] and [[ventricular tachycardia]])
+| style="background: #F5F5F5; padding: 5px;" |
+*[[CXR]]: [[Cardiomegaly]]
+*[[Echocardiography]]: ↓ EF
+*[[Right heart catheterization]]: [[Pulmonary capillary wedge pressure]] >20 mmHg, [[right atrial pressure]] ≥12 mmHg) and/or decreased [[cardiac index]] (≤2.2 L/min/m2
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Echocardiography]]
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! rowspan="3" |Differentials on the basis of Etiology
+! rowspan="3" |Differentials on the Basis of Etiology
 ! rowspan="3" |Disease
-! colspan="9" |Clinical manifestations
+! colspan="10" |Clinical Manifestations
 ! colspan="4" |Diagnosis
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 | colspan="8" |Symptoms
-! rowspan="2" |Physical exam
+| rowspan="2" |Risk Factors
-! rowspan="2" |Lab Findings
+! rowspan="2" |Physical Exam
+! rowspan="2" |Lab Findings
 ! rowspan="2" |EKG
 ! rowspan="2" |Imaging
-! rowspan="2" |Gold standard
+! rowspan="2" |Gold Standard
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 !Onset
 !Duration
-!Type of Pain
+!Quality of Pain
 !Cough
 !Fever
 !Dyspnea
-!Weight loss
+!Weight Loss
 !Associated Features
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
 ! rowspan="12" |Pulmonary
-|'''[[Pulmonary Embolism]]'''
+!'''[[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]]
 | style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
 | style="background: #F5F5F5; padding: 5px;" |
-*Sharp or knifelike or pleuritic pain
+*Sharp or knifelike or [[pleuritic pain]]
 *Localized to side of lesion
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 359: / Line 638: @@
 *[[Hemoptysis]]
 *History of [[venous thromboembolism]] or [[coagulation]] abnormalities.
+| style="background: #F5F5F5; padding: 5px;" | [[Hormone replacement therapy]]
+[[Cancer]]
+[[Oral contraceptive pills]]
+[[Stroke]]
+[[Pregnancy]]
+[[Postpartum]]
+Prior history of [[VTE]]
+[[Thrombophilia]]
 | style="background: #F5F5F5; padding: 5px;" |
 *[[S3]] or [[S4]] [[Gallop rhythm|gallop]]
+*Low grade fever
+*[[Tachycardia]]
+*[[Tachypnea]]
+*[[Hypoxia]]
 | style="background: #F5F5F5; padding: 5px;" |
-*↑[[D-dimer]]
+*↑[[D-dimer]] ≥500 ng/mL
-*[[Arterial blood gas|Arterial blood gases]] (Respiratory alkalosis)
+*[[Arterial blood gas|Arterial blood gases]] ([[Respiratory alkalosis]])
 *↑[[Troponin|Troponin levels]]
+*[[Hypercoagulation]] workup
 | style="background: #F5F5F5; padding: 5px;" |
-*Tachycardia and nonspecific ST-segment and T-wave changes (70 percent)
+*[[Tachycardia]] and nonspecific [[ST-segment]] and [[T-wave]] changes (70 percent)
 *S1Q3T3 pattern
-*New right bundle branch block
+*New [[right bundle branch block]]
 *Inferior Q-waves (leads II, III, and aVF)
 | style="background: #F5F5F5; padding: 5px;" |
-*Duplex Ultrasonography
+*[[Duplex Ultrasonography]]: [[DVT]]
-*Echocardiography
+*[[CXR]]: [[Westermark sign]], [[Hampton hump]], [[Palla's sign]]
-*Venography
+*[[Echocardiography]]:
-*Ventilation-Perfusion Scanning
+** [[RV]] dilation (ratio of apical 4-chamber [[RV]] diameter to [[LV|left ventricle (LV)]] diameter > 0.9)
+** [[RV]] systolic dysfunction
+*[[Ventilation-Perfusion Scanning]]: High probability
 | style="background: #F5F5F5; padding: 5px;" |
-*CT pulmonary angiography
+*[[CT pulmonary angiography]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Pneumothorax|Spontaneous Pneumothorax]]'''
+!'''[[Pneumothorax|Spontaneous Pneumothorax]]'''<ref name="pmid3678419">{{cite journal |vauthors=Bense L, Wiman LG, Hedenstierna G |title=Onset of symptoms in spontaneous pneumothorax: correlations to physical activity |journal=Eur J Respir Dis |volume=71 |issue=3 |pages=181–6 |date=September 1987 |pmid=3678419 |doi= |url=}}</ref><ref name="pmid8553937">{{cite journal |vauthors=Seow A, Kazerooni EA, Pernicano PG, Neary M |title=Comparison of upright inspiratory and expiratory chest radiographs for detecting pneumothoraces |journal=AJR Am J Roentgenol |volume=166 |issue=2 |pages=313–6 |date=February 1996 |pmid=8553937 |doi=10.2214/ajr.166.2.8553937 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Acute
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
 | style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
 | style="background: #F5F5F5; padding: 5px;" |
 *Sharp
-*Localized pleuritic
+*Localized [[pleuritic]]
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | -
@@ Line 395: / Line 689: @@
 *Decreased [[tactile fremitus]]
 *[[Tachycardia]]
-*Cardiac apical displacement
+*Cardiac [[apical displacement]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Smoking
+* Positive family history
+* [[Marfan syndrome]]
+* [[Homocystinuria]]
+* [[Thoracic]] [[endometriosis]].
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Decreased breath sounds]] on involved side
-*[[Respiratory sounds|Lung sounds]] transmitted from the unaffected hemithorax are minimal with [[auscultation]] at the midaxillary line
+*[[Respiratory sounds|Lung sounds]] transmitted from the unaffected [[hemithorax]] are minimal with [[auscultation]] at the [[midaxillary]] line
 *Adventitious lung sounds ([[crackles]], [[wheeze]]; an ipsilateral finding)
 *[[Pulsus paradoxus]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Respiratory alkalosis on [[Arterial blood gases|ABGs]]
+*[[Respiratory alkalosis]] on [[Arterial blood gases|ABGs]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Rightward shift in the mean electrical axis
-*Loss of precordial R waves
+*Loss of [[precordial]] R waves
 *Diminution of the QRS voltage
 *Precordial T wave inversions
 | style="background: #F5F5F5; padding: 5px;" |
-*CXR: White visceral pleural line on the chest radiograph
+*[[CXR]]: White [[visceral]] pleural line on the chest radiograph
-*Contrast-Enhanced Esophagography
+*[[CT]]: small amounts of [[intrapleural]] gas, atypical collections of [[pleural]] gas, and loculated pneumothoraces
-*Computed Tomography of Chest
 | style="background: #F5F5F5; padding: 5px;" |
 *CT scan
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tension Pneumothorax]]
+!style="background: #DCDCDC; padding: 5px;" |[[Tension Pneumothorax]]<ref name="pmid8820023">{{cite journal |vauthors=Stark P, Leung A |title=Effects of lobar atelectasis on the distribution of pleural effusion and pneumothorax |journal=J Thorac Imaging |volume=11 |issue=2 |pages=145–9 |date=1996 |pmid=8820023 |doi= |url=}}</ref><ref name="pmid23179505">{{cite journal |vauthors=Jalli R, Sefidbakht S, Jafari SH |title=Value of ultrasound in diagnosis of pneumothorax: a prospective study |journal=Emerg Radiol |volume=20 |issue=2 |pages=131–4 |date=April 2013 |pmid=23179505 |doi=10.1007/s10140-012-1091-7 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Acute
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
 | style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
 | style="background: #F5F5F5; padding: 5px;" |
 *Sharp
-*Pleuritic
+*[[Pleuritic]]
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | -
@@ Line 429: / Line 728: @@
 *[[Jugular venous distention]]
 *[[Respiratory distress]]
+| style="background: #F5F5F5; padding: 5px;" |
+*Trauma
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Decreased breath sounds]] on involved side
-*[[Respiratory sounds|Lung sounds]] transmitted from the unaffected hemithorax are minimal with [[auscultation]] at the midaxillary line
+*[[Respiratory sounds|Lung sounds]] transmitted from the unaffected [[hemithorax]] are minimal with [[auscultation]] at the [[midaxillary]] line
-*Adventitious [[Respiratory sounds|lung sounds]] ([[crackles]], [[wheeze]]; an ipsilateral finding)
+*Adventitious [[Respiratory sounds|lung sounds]] ([[crackles]], [[wheeze]]; an [[ipsilateral]] finding)
 *[[Pulsus paradoxus]]
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Arterial blood gases|ABGs]]
+*[[Arterial blood gases|Respiratory alkalosis on ABGs]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Significant elevation of the ST-T segment from leads V1 to V4
 | style="background: #F5F5F5; padding: 5px;" |
-*CXR
+*[[CXR]]: A distinct shift of the [[mediastinum]] to the [[contralateral]] side, collapse of the [[ipsilateral]] lung, and flattening or inversion of the [[ipsilateral]] [[hemidiaphragm]]
-*Contrast-Enhanced Esophagography
-*Computed Tomography of Chest
-*Ultrasonography
 | style="background: #F5F5F5; padding: 5px;" |
-*CT scan
+*[[CT scan]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Pneumonia]]
+![[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;" |[[Acute]] or [[chronic]]
 | style="background: #F5F5F5; padding: 5px;" |Variable
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 463: / Line 761: @@
 *Red currant-jelly [[sputum]]
 *[[Central cyanosis]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Long hospital stay
+* Ill contact exposure
+* [[Aspiration]]
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Wheezing]]
@@ Line 470: / Line 772: @@
 *[[Pleural friction rub]]
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Arterial blood gases|Arterial blood gas]]
+*[[Arterial blood gases|Arterial blood gas]] : [[Hypoxia]], [[hypoxemia]]
-*Venous blood gas determination
+*↑ [[Procalcitonin]]
-*[[Complete blood count|Complete blood cell (CBC) count with differential]]
+*[[Leukocytosis]]
 *[[Sputum culture|Sputum evaluation]]
-*Blood cultures
+*Positive blood cultures
-*BMP
 | style="background: #F5F5F5; padding: 5px;" |
-*Sinus tachycardia
+*[[Sinus tachycardia]]
-*Nonspecific ST-segment or T-wave changes
+*Nonspecific [[ST-segment]] or T-wave changes
 | style="background: #F5F5F5; padding: 5px;" |
-*CXR: lung infiltrates
+*[[CXR]]: [[Interstitial infiltrates]], [[lobar]] consolidation, [[cavitation]]
-*Chest CT Scanning
-*Chest Ultrasonography
-*Thoracocentesis
-*Bronchoscopy with or without BAL
 | style="background: #F5F5F5; padding: 5px;" |
-*Presence of lung infiltrates on CXR
+*[[CXR]]
-*Blood culture
+|- style="background: #DCDCDC; padding: 5px;" |
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+![[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>
-|[[Tracheitis]]/ [[Bronchitis]]
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
-| style="background: #F5F5F5; padding: 5px;" |Acute
 | style="background: #F5F5F5; padding: 5px;" |Variable
 | style="background: #F5F5F5; padding: 5px;" |
 *Dull
-*Substernal
+*[[Substernal]]
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 508: / Line 804: @@
 *[[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;" |
-*Obtain [[Bacterial cultures|bacterial culture]] and [[Gram staining|Gram stain]] of tracheal secretions and [[blood cultures]]
+*[[Gram stain]] of [[exudates]]: [[Neutrophils]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Peaked P-wave
 | style="background: #F5F5F5; padding: 5px;" |
-*Radiography of the neck
+*Radiography of the neck: [[Steeple sign]]
-*Laryngotracheobronchoscopy
+*[[Laryngotracheobronchoscopy]]: a normal [[epiglottis]] with [[subglottic]] narrowing, thick and purulent secretions in the [[trachea]], [[pseudomembranes]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Bronchoscopy
+*[[Endoscopy]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Pleuritis]]'''
+!'''[[Pleuritis]]'''
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic
+| 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
+*Localized [[pleuritic]]
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 536: / Line 836: @@
 *[[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;" |
-*[[Complete blood count|CBC]]
+*[[Leukocytosis]]
-*[[Blood cultures]]
+*[[Arterial blood gases|Arterial blood gas (ABG)]]: [[Hypoxia]]
-*[[Arterial blood gases|Arterial blood gas (ABG)]]
+*[[Thoracentesis|Thoracocentesis]]
-*[[Thoracentesis]]
 | style="background: #F5F5F5; padding: 5px;" |
-*EKG done to rule out other causes in differential diagnoses
+*[[EKG]] done to rule out other causes in differential diagnoses
 | style="background: #F5F5F5; padding: 5px;" |
-*Chest X Ray
+*[[Chest X Ray]]: [[Pleural fluid]] on one or both sides
-*Computerized tomography (CT) scan
+*[[Computerized tomography]] (CT) scan: [[Pleural effusions]]
-*Ultrasound
 | style="background: #F5F5F5; padding: 5px;" |
-*Video assisted thoracoscopic surgery
+*[[CXR]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Pulmonary Hypertension]]'''
+!'''[[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;" |[[Acute]] or [[subacute]] or [[chronic]]
 | style="background: #F5F5F5; padding: 5px;" |Variable
 | style="background: #F5F5F5; padding: 5px;" |
-*Substernal pressure like
+*[[Substernal]] pressure like
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" | -
@@ Line 567: / Line 871: @@
 *[[Arthritis]] or [[Arthralgia|arthralgias]]
 *[[Rash]]
-*Family history of [[pulmonary hypertension]]
+| style="background: #F5F5F5; padding: 5px;" |
-*Heavy [[snoring]]
+* Smoking
-*Heavy [[Alcohol consumption and health|alcohol consumption]]
+* [[HF]]
-*[[Drug use]], in particularly diet drugs
+* Heavy [[snoring]]
-*[[Morbid obesity]]
+* [[Morbid obesity]]
-*Heavy [[Alcohol consumption and health|alcohol consumption]]
 | 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]].
@@ Line 578: / Line 881: @@
 *A [[S4|right-sided fourth heart sound (S4)]] with a left [[parasternal heave]]
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Complete blood count|Complete blood count (CBC)]]
+*Abnormal [[Arterial blood gases|Arterial blood gas]]
-*[[Basic metabolic panel|Biochemistry panel]]
-*[[Prothrombin time (PT)]]
-*[[Activated partial thromboplastin time|Activated partial thromboplastin time (aPTT)]]
-*[[Arterial blood gases|Arterial blood gas]]
-*[[Erythrocyte sedimentation rate|Erythrocyte sedimentation rate (ESR)]]
-*[[Rheumatoid factor|Rheumatoid factor (RF) levels]]
 *[[Antinuclear antibody|Antinuclear antibody (ANA) levels]]
 *[[Anti-neutrophil cytoplasmic antibody|Antineutrophil cytoplasmic antibody (ANCA)]]
-*SCL70
-*[[Liver function tests|Liver function test results]]
 *[[Brain natriuretic peptide|Brain natriuretic peptide (BNP of NT-proBNP)]]
 *[[HIV testing]]
@@ Line 595: / Line 890: @@
 *[[Polysomnography]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Right axis deviation
+*[[Right axis deviation]]
 *An R wave/S wave ratio greater than one in lead V1
-*Incomplete or complete right bundle branch block
+*Incomplete or complete [[right bundle branch block]]
-*Increased P wave amplitude in lead II (P pulmonale) due to right atrial enlargement
+*Increased P wave amplitude in lead II (P pulmonale) due to right [[atrial enlargement]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Chest Radiography
+*[[Chest Radiography]]: [[Oligemic]] lung fields
-*Echocardiography
+*[[Echocardiography]]:  [[PASP]] is >50 and the TRV is >3.4
-*Ventilation-Perfusion Lung Scanning
+*[[Ventilation-Perfusion (V/Q) Lung Scanning]]: Abnormal
-*Right-Sided Cardiac Catheterization
+*Right-sided [[cardiac catheterization]]: Mean [[PCWP]] >15 mmHg,
 | style="background: #F5F5F5; padding: 5px;" |
-*Cardiac catheterization
+*[[Cardiac catheterization]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Pleural Effusion]]
+![[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>
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]] or [[chronic]]
 | style="background: #F5F5F5; padding: 5px;" |Variable
 | style="background: #F5F5F5; padding: 5px;" |
 *Dull
-*Pleuritic pain
+*[[Pleuritic]] pain
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" | +/-
@@ Line 618: / Line 913: @@
 | style="background: #F5F5F5; padding: 5px;" | +/-
 | style="background: #F5F5F5; padding: 5px;" |
-*Increasing lower extremity edema
+*Increasing lower extremity [[edema]]
 *[[Orthopnea]]
 *[[Paroxysmal nocturnal dyspnea]]
 *[[Night sweats]]
 *[[Hemoptysis]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Pneumonia]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Diminished or inaudible [[breath sounds]]
@@ Line 628: / Line 925: @@
 *[[Egophony]] (known as "E-to-A" changes)
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Pleural fluid]] [[LDH]], [[glucose]] and [[pH]]
+*[[Pleural fluid|Pleural fluid LDH levels above 1000 IU/L]]  [[Complete blood count|Nucleated cells]]
-*[[Complete blood count|CBC]]
+** [[Complete blood count|- Lymphocytosis]]
-*[[Pleural fluid]] Cell Count Differential
+** [[Complete blood count|- Eosinophilia]]
+** [[Complete blood count|- Mesothelial cells]]
 *[[Pleural fluid]] culture and [[cytology]]
-*[[Pleural fluid]] [[amylase]] levels
-*[[Pleural fluid]] [[triglyceride]] and [[Cholesterol|cholesterol levels]]
 *[[Pleural fluid]] [[Anti-nuclear antibody|antinuclear antibody]] and [[rheumatoid factor]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Typically not indicated
 | style="background: #F5F5F5; padding: 5px;" |
-*CT Scanning
+*[[Chest X Ray]]: [[Pleural fluid]] on one or both sides
-*Ultrasonography
+*[[Computerized tomography (CT)]] scan: Detects small [[pleural effusions]], ie, less than 10 mL and possibly as little as 2 mL of liquid in the [[pleural space]], Thickening of the [[visceral]] and [[parietal pleura]]
-*Chest Radiography
+*MRI: Characterize the content of [[pleural effusions]]
-*Diagnostic Thoracentesis
-*Pleural biopsy
 | style="background: #F5F5F5; padding: 5px;" |
-*Computed tomography
+*[[Computed tomography]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Asthma]] & [[COPD]]
+![[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;" |[[Acute]] or [[subacute]] or [[chronic]]
 | style="background: #F5F5F5; padding: 5px;" |Variable
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 657: / Line 951: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Cyanosis]]
-*[[Elevated jugular venous pressure|Elevated jugular venous pulse (JVP]])
-*[[Peripheral edema]]
-*Hyperinflation ([[barrel chest]])
-*Rapidity of onset
-*Signs of [[atopy]] or [[allergic rhinitis]]
-*Nail [[clubbing]]
 | 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;" |
-*[[Pulmonary function tests]]
+*[[Leukocytosis]]
-*[[ABG|Arterial Blood Gas Analysis]]
+*[[Eosinophilia]]
-*[[Electrolyte disturbance|Serum Chemistries]]
+*[[Respiratory alkalosis]]
-*[[Alpha 1-antitrypsin deficiency|Alpha1-Antitrypsin]]
-*[[Sputum culture|Sputum Evaluation]]
-*[[BNP|B-Type Natriuretic Peptide]]
-*[[Blood]] and [[Sputum]] [[Eosinophils]]
-*Serum Immunoglobulin E
-*[[Pulse oximetry|Pulse Oximetry Assessment]]
-*[[Skin allergy testing|Allergy Skin Testing]]
-*[[Bronchoprovocation test|Bronchoprovocation]]
-*[[Alpha 1-antitrypsin deficiency|Alpha1-Antitrypsin]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Peaked P-wave
-*Reduced amplitude of the QRS complexes
+*Reduced amplitude of the [[QRS complexes]]
-*Multifocal atrial tachycardia (MAT)
+*[[Multifocal atrial tachycardia]] (MAT)
 | style="background: #F5F5F5; padding: 5px;" |
-*Chest Radiography
+*[[CXR]]: [[Hyperinflation]]
-*Chest CT Scanning
+*[[Spirometry]]: ↓ [[FEV1]], [[Peak expiratory flow|PEF]], ↓ [[FEV1]]/[[FVC]]
-*Electrocardiography
-*MRI
-*Nuclear Imaging
 | style="background: #F5F5F5; padding: 5px;" |
-*Spirometry
+*[[Spirometry]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Lung Cancer|Pulmonary Malignancy]]
+![[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;" |Week to months
+| style="background: #F5F5F5; padding: 5px;" |Variable
 | style="background: #F5F5F5; padding: 5px;" |
 *Dull aching
@@ Line 705: / Line 990: @@
 *[[Bone pain]]
 *[[Fatigue]]
-*Neurologic dysfunction
+*[[Neurologic dysfunction]]
 *[[Superior vena cava syndrome|Superior vena cava (SVC) obstruction]]
 *[[Hoarseness]]
@@ Line 713: / Line 998: @@
 *[[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;" |
-*[[Complete blood cell count]]
+*[[Hypercalcemia]]
-*[[Basic metabolic panel|Serum chemistries]]
-*[[Transthoracic needle aspiration]]
-*[[Thoracoscopy]]
-*[[Electrolyte disturbance|Serum electrolytes levels]]
-*[[Liver function tests|Liver function tests (LFTs)]]
-*[[Renal function tests|Renal function tests (RFTs)]]
-*[[LDH|Serum lactate dehydrogenase (LDH) level]]
-*[[ALP|Serum alkaline phosphatase (ALP) level]]
 | 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
+*[[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;" |
-*Chest radiography
+*[[CXR]] and [[CT scan]]: Mass lesion, [[hilar lymphadenopathy]]
-*CT scanning of the chest and abdomen
+*[[Spirometry]]: ↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
-*Endobronchial ultrasound (EBUS)
+*[[Bronchoscopy]]: [[Biopsy]]
-*Endoscopic ultrasound
-*CT scanning/magnetic resonance imaging (MRI) of the brain with IV contrast
-*Bone scanning
 | style="background: #F5F5F5; padding: 5px;" |
-*CT Scan
+*[[Bronchoscopy]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Sarcoidosis]]
+![[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
@@ Line 744: / Line 1,023: @@
 | 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]])
@@ Line 754: / Line 1,033: @@
 *[[Hypercalciuria]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Not any significant auscultatory finding
+* Black population
+* [[Autoimmune]] diseases
+| style="background: #F5F5F5; padding: 5px;" |
+*Diminished respiratory sounds
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Serum amyloid A|Serum amyloid A (SAA)]], soluble [[Interleukin-2 receptor|interleukin-2 receptor (sIL-2R)]], [[lysozyme]], [[Angiotensin-converting enzyme|angiotensin-converting enzyme (ACE)]] and the [[Glycoprotein|glycoprotein KL-6]]
+*↑ [[ACE level]], [[adenosine deaminase]], SAA, sIL2R
-*Elevated 1,25-dihydroxyvitamin D levels
+*[[Hypercalciuria]]
-*[[Complete blood count|CBC]]
+*Elevated [[1,25-dihydroxyvitamin D]] levels
-*[[Liver function tests|LFTS]]
-*[[Renal function tests|Kidney function test]]
-*[[Urinalysis|Urine DR]]
-*Carbon monoxide diffusion capacity test
 | style="background: #F5F5F5; padding: 5px;" |
-*AV block
+*[[AV block]]
-*Prolongation of the PR interval (first-degree AV block)
+*Prolongation of the [[PR interval]] (first-degree AV block)
-*Ventricular arrhythmias (sustained or nonsustained ventricular tachycardia and ventricular premature beats [VPBs])
+*[[Ventricular arrhythmias]] (sustained or nonsustained [[ventricular tachycardia]] and ventricular premature beats [VPBs])
-*Supraventricular arrhythmias
+*[[Supraventricular arrhythmias]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Chest radiograph
+*[[Chest radiograph]]: [[Bilateral hilar adenopathy]]
-*Pulmonary function tests
+*High-resolution CT (HRCT) scanning of the chest: [[Ground glass]] opacification, Hilar and [[mediastinal lymphadenopathy]],    [[Bronchial]] wall thickening
-*High-resolution CT (HRCT) scanning of the chest
 | style="background: #F5F5F5; padding: 5px;" |
-*Lung Biopsy
+*Lung [[Biopsy]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Acute chest syndrome]] ([[Sickle cell anemia|Sickle cell anemia)]]
+![[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>
-| style="background: #F5F5F5; padding: 5px;" |Acute
+| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
 | style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 788: / Line 1,065: @@
 *Vaso-occlusive [[Crisis (charity)|crisis]]
 *[[Pain]] crises
+| style="background: #F5F5F5; padding: 5px;" |
+* ↑ [[WBC]]
+* ↑ [[Hb]] levels
+* ↓ [[fetal hemoglobin]] levels
+* Smoking
+* Vaso-occlusive pain events
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Systolic murmurs|Systolic murmur]] may be heard over the entire [[precordium]]
 | style="background: #F5F5F5; padding: 5px;" |
-*[[CBC]]
+*↑[[Erythrocyte sedimentation rate]]
-*[[Erythrocyte sedimentation rate]]
+*[[Peripheral blood smear|Peripheral blood smears]]: [[Schistiocytes]]
-*[[Peripheral blood smear|Peripheral blood smears]]
+*↑ [[Reticulocyte count|Reticulocyte count]]
-*[[Reticulocyte count|The reticulocyte count]]
-*[[Arterial blood gases]]
-*Sickling test
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG typically not indicated
 | style="background: #F5F5F5; padding: 5px;" |
-*Chest radiography
+*[[EKG]] typically not indicated
-*Plain radiography of the extremities
-*Magnetic Resonance Imaging
-*Computed Tomography
-*Nuclear Medicine Scans
-*Transcranial Doppler Ultrasonography
-*Abdominal Ultrasonography
-*Echocardiography
 | style="background: #F5F5F5; padding: 5px;" |
-*No any gold standard test for acute chest syndrome
+*Plain radiography of the extremities: [[Avascular necrosis]]
+| style="background: #F5F5F5; padding: 5px;" | ---
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! rowspan="3" |Differentials on the basis of Etiology
+! rowspan="3" |Differentials on the Basis of Etiology
 ! rowspan="3" |Disease
-! colspan="9" |Clinical manifestations
+! colspan="10" |Clinical Manifestations
 ! colspan="4" |Diagnosis
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 | colspan="8" |Symptoms
-! rowspan="2" |Physical exam
+| rowspan="2" |Risk Factors
-! rowspan="2" |Lab Findings
+! rowspan="2" |Physical Exam
+! rowspan="2" |Lab Findings
 ! rowspan="2" |EKG
 ! rowspan="2" |Imaging
-! rowspan="2" |Gold standard
+! rowspan="2" |Gold Standard
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 !Onset
 !Duration
-!Type of Pain
+!Quality of Pain
 !Cough
 !Fever
 !Dyspnea
-!Weight loss
+!Weight Loss
 !Associated Features
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
 | rowspan="9" |Gastrointestinal
-|'''[[GERD]], [[Peptic Ulcer]]'''
+!'''[[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>
 | style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Minutes to hours ([[Gastroesophageal reflux disease|gastroesophageal reflux]])
 *Prolonged ([[peptic ulcer]])
+*5 to 60 minutes
 | style="background: #F5F5F5; padding: 5px;" |
 *Burning
-*Substernal
+*[[Substernal]]
 *[[Epigastric]]
 | style="background: #F5F5F5; padding: 5px;" | +/-
@@ Line 847: / Line 1,121: @@
 | style="background: #F5F5F5; padding: 5px;" | +/-
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Enamel]] [[Erosion (dental)|erosion]] or other dental manifestations
+*[[Visceral]], [[substernal]], worse with recumbency, no radiation, relief with food, antacids
-*[[Heartburn]]
-*[[Regurgitation]]
-*[[Dysphagia]]
 *[[Hematemesis]] or [[melena]] resulting from [[gastrointestinal bleeding]]
 *[[Dyspepsia]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Prolonged [[NSAIDs]] intake
+* Smoking
+* Alcohol abuse
+* Spicy foods
+* [[H-pylori infection]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Not any auscultatory findings associated with this disease
+*[[Enamel]] [[Erosion (dental)|erosion]] or other dental manifestations
 | style="background: #F5F5F5; padding: 5px;" |
-*Serum [[Gastrin]] Level
+*↑Serum [[Gastrin]] Level
-*Secretin Stimulation Test
+*[[Secretin Stimulation Test]]
-*Ambulatory 24-Hour pH Monitoring
+*[[H-Pylori testing]]
 | style="background: #F5F5F5; padding: 5px;" |
-*An electrocardiogram (ECG) can show T wave inversions in leads V2 through V4 consistent with myocardial ischemia in patients with peptic ulcer perforation
+* [[EKG]] usually normal but may show [[T wave inversions]] in leads V2 through V4 consistent with [[myocardial ischemia]] in patients with [[peptic ulcer]] perforation
 | style="background: #F5F5F5; padding: 5px;" |
-*Upper Gastrointestinal Endoscopy
+*Upper [[Gastrointestinal]] [[Endoscopy]]: [[Biopsy]]
-*Esophageal Manometry
+*[[Esophageal Manometry]]: To exclude an esophageal motility disorder
-*Barium esophagogram
+*Esophageal impedance pH testing: Monitors esophageal [[pH]]
-*Ambulatory reflux monitoring
-*Nuclear Medicine Gastric Emptying Study
-*Intraluminal Esophageal Electrical Impedance
 | style="background: #F5F5F5; padding: 5px;" |
-*Ambulatory pH monitoring
+*Upper [[Gastrointestinal]] [[Endoscopy]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|'''Diffuse Esophageal Spasm'''
+!'''[[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
-*Retrosternal
+*[[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;" |
-*Not specific
+*Associated with cold liquids
-| style="background: #F5F5F5; padding: 5px;" |
+*Relief with [[nitroglycerin]]
-*No any specific finding on [[physical examination]]
+| style="background: #F5F5F5; padding: 5px;" | ---
+| style="background: #F5F5F5; padding: 5px;" | ---
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Blood glucose|Blood glucose levels]]
+*[[Barium swallow]]: Multiple areas of [[spasm]]  throughout the length of the esophagus
-*[[HbA1c|Hemoglobin A1C levels]]
+*Impedance testing: Higher amplitudes and better transit of swallowed boluses
-*[[Esophagogastroduodenoscopy|Esophagogastroduodenoscopy (EGD), or upper endoscopy]]
 | 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
+*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;" |
-*Barium swallow
+*Esophageal [[Esophageal motility study|manometry]] : ≥20 percent premature contractions (distal latency <4.5 seconds)
-*Esophageal [[Esophageal motility study|manometry]] is more than 20% premature contractions
-*CT scanning
-*Ultrasonography
 | style="background: #F5F5F5; padding: 5px;" |
-*Esophageal manometry
+* [[Esophageal manometry]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Esophagitis]]
+![[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>
 | style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
 | style="background: #F5F5F5; padding: 5px;" |Variable
@@ Line 911: / Line 1,185: @@
 | style="background: #F5F5F5; padding: 5px;" | +/-
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Heartburn]] ([[dyspepsia]])
+*[[Heartburn]]
 *[[Abdominal pain]]
 | style="background: #F5F5F5; padding: 5px;" |
-*No auscultatory finding in the this [[disease]]
+* [[HIV]]
+* [[Immunosuppression]]
+| style="background: #F5F5F5; padding: 5px;" |
+*No auscultatory finding
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Cardiac troponin I (cTnI) and T (cTnT)|Troponin or other cardiac markers]]
-*[[Complete blood count|Complete blood (CBC) cell count]]
+*[[Leukopenia]]
-*[[CD4|CD4 count]]
+*↓[[CD4|CD4 count]]
 *[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus (HIV) test]]
-*Collagen disorder workup
-*Blind Brush [[Cytology]]
 | style="background: #F5F5F5; padding: 5px;" |
-*ECG is done to rule out acute coronary syndrome for the cause of chest pain
+*ECG is done to rule out [[acute coronary syndrome]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Double-contrast esophageal barium study (esophagography)
+*Double-contrast esophageal [[barium study]] ([[esophagography]])
-*Endoscopy
+*[[Endoscopy]]: [[Biopsy]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Biopsy
+*[[Endoscopy]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Eosinophilic esophagitis|Eosinophilic Esophagitis]]
+![[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
+*[[Retrosternal]]
 *Abdominal
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 941: / Line 1,216: @@
 | 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]]
@@ Line 949: / Line 1,228: @@
 *No auscultatory finding in the this [[disease]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Elevated IgE
+*Elevated [[IgE]] (>114,000 units/L)
-*Elevated peripheral eosinophils
+*Elevated peripheral [[eosinophils]]
-*Skin prick testing
-*Blood allergy testing
-*Atopy patch testing
 | style="background: #F5F5F5; padding: 5px;" |
 *Typically no finding on EKG
 | style="background: #F5F5F5; padding: 5px;" |
-*Barium studies
+*[[Barium studies]]: [[Strictures]] and a ringed esophagus
-*Endoscopy
+*[[Endoscopy]]: Stacked circular rings ("feline" esophagus)  ●[[Strictures]]   ●Linear furrows   ●Whitish papules
-*CT scan
+*[[Esophageal biopsy]]: More than 15 [[Eosinophil granulocyte|eosinophils]] per high-power field
-*MRI
 | style="background: #F5F5F5; padding: 5px;" |
-*More than 15 [[Eosinophil granulocyte|eosinophils]] per high-power field
+*Esophageal [[biopsy]]
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Esophageal perforation|Esophageal Perforation]]
+![[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>
 | style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
 | style="background: #F5F5F5; padding: 5px;" |Minutes to hours
@@ Line 979: / Line 1,254: @@
 *[[Subcutaneous emphysema]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Auscultatory findings of [[pleural effusion]]
+* [[Instrumentation]]/surgery
+* Penetrating or blunt trauma
+* Medications, other ingestions, foreign body
+* Violent retching/[[vomiting]]
+* Hernia/intestinal [[volvulus]]/obstruction
+* [[Inflammatory bowel disease]]
+* [[Appendicitis]]
+* [[Peptic ulcer disease]]
+| style="background: #F5F5F5; padding: 5px;" |
+*Mild [[tachycardia]] or [[hypothermia]]
 *[[Hamman's crunch|Hamman crunch (crackling sound upon chest auscultation occurs due to pneumomediastinum)]]
 | style="background: #F5F5F5; padding: 5px;" |
-*CBC
+*↑Serum [[amylase]]
-*Serum albumin levels
+*↑[[C-reactive protein]] levels
-*Thoracentesis with examination of the pleural fluid
 | style="background: #F5F5F5; padding: 5px;" |
-*EKG may be indicated to assess for [[myocardial ischemia]] due to [[Gastrointestinal bleeding|acute gastrointestinal bleeding]], especially if there is coexisting:Cardiovascular disease, significant anemia and advanced age
+*[[EKG]] may be indicated to assess for [[myocardial ischemia]] due to [[Gastrointestinal bleeding|acute gastrointestinal bleeding]], especially if there is coexisting:Cardiovascular disease, significant [[anemia]] and advanced age
 | style="background: #F5F5F5; padding: 5px;" |
-*Water-soluble contrast esophagram
+*Plain chest films or chest [[CT]]: [[Pneumomediastinum]], Free air under the [[diaphragm]],  •[[Pleural effusion]]   •[[Pneumothorax]] (Macklin effect).    •[[Subcutaneous emphysema]]
+*Plain abdominal films (or abdominal CT scout film):The appearance of [[pneumoperitoneum]]   -Free air under the diaphragm   -Cupola sign (inverted cup)   -Rigler sign (double-wall sign)   -Psoas sign  -Urachus sign
 | style="background: #F5F5F5; padding: 5px;" |
-*Iodine, water-soluble contrast medium esophagography
+** Confirmed by water-soluble contrast esophagram
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Mediastinitis]]
+![[Mediastinitis]]<ref name="pmid3045478">{{cite journal |vauthors=Loyd JE, Tillman BF, Atkinson JB, Des Prez RM |title=Mediastinal fibrosis complicating histoplasmosis |journal=Medicine (Baltimore) |volume=67 |issue=5 |pages=295–310 |date=September 1988 |pmid=3045478 |doi= |url=}}</ref><ref name="pmid762913">{{cite journal |vauthors=Feigin DS, Eggleston JC, Siegelman SS |title=The multiple roentgen manifestations of sclerosing mediastinitis |journal=Johns Hopkins Med J |volume=144 |issue=1 |pages=1–8 |date=January 1979 |pmid=762913 |doi= |url=}}</ref><ref name="pmid3539049">{{cite journal |vauthors=Garrett HE, Roper CL |title=Surgical intervention in histoplasmosis |journal=Ann. Thorac. Surg. |volume=42 |issue=6 |pages=711–22 |date=December 1986 |pmid=3539049 |doi= |url=}}</ref><ref name="pmid7774324">{{cite journal |vauthors=Sherrick AD, Brown LR, Harms GF, Myers JL |title=The radiographic findings of fibrosing mediastinitis |journal=Chest |volume=106 |issue=2 |pages=484–9 |date=August 1994 |pmid=7774324 |doi= |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]], [[Chronic (medical)|Chronic]]
 | style="background: #F5F5F5; padding: 5px;" |Variable
@@ Line 1,004: / Line 1,288: @@
 *Nonspecific
 | style="background: #F5F5F5; padding: 5px;" |
-*Crunching sound heard with a stethoscope over the precordium during systole called as [[Hamman's sign|Hamman sign]]
+* Infection
+* Esophageal perforation
+* Post operative complication
+| style="background: #F5F5F5; padding: 5px;" |
+*Dysphagia
+*Dysphonia
+*Stridor
+*[[Hamman's sign|Hamman sign]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Positive organisms in sternal [[Culture collection|culture]]
-*Complete blood count (CBC)
+*Leukocytosis
-*Blood cultures
+*Positive blood cultures
 | style="background: #F5F5F5; padding: 5px;" |
 *Diffuse ST elevation
 | style="background: #F5F5F5; padding: 5px;" |
-*CT
+*CT: Localize the infection and extent of spread
-*Chest X-Ray
+*MRI: Assesses vascular  involvement and complications
-*Magnetic resonance imaging
+| style="background: #F5F5F5; padding: 5px;" | CT scan
-*Nuclear medicine
+|- style="background: #DCDCDC; padding: 5px;" |
-| style="background: #F5F5F5; 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>
-*No any gold standard test for this disease yet
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
-|'''[[Gallstone disease| Cholelithiasis]]'''
 | style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]], [[subacute]]
 | style="background: #F5F5F5; padding: 5px;" |Minutes to hours
@@ Line 1,030: / Line 1,318: @@
 | 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
+*Fertile females in 40's
 | style="background: #F5F5F5; padding: 5px;" |
-*No auscultatory finding associated with this [[disease]]
+*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;" |
-*LFT's
+*Murphy sign negative
-*[[Amylase]] levels
+*Jaundice
-*Llipase levels
+| style="background: #F5F5F5; padding: 5px;" |
-*CBC
+*↑ALT
+*↑AST
+*↑[[Amylase]] levels
+*↑ALP
 | style="background: #F5F5F5; padding: 5px;" |
 *Typically not indicated
 | style="background: #F5F5F5; padding: 5px;" |
-*Transabdominal [[ultrasound]] (TAUS)
+*Transabdominal [[ultrasound]] (TAUS): shows gallstones
-*Abdominal Radiography
+*EUS: Detects biliary sludge
-*CT Scan
+*MRCP: Detects stones >6mm
-*Magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP)
+*Endoscopic Retrograde Cholangiopancreatography (ERCP): Diagnostic and therapeutic removal of stones
-*Scintigraphy
-*Endoscopic Retrograde Cholangiopancreatography (ERCP)
-*Percutaneous Transhepatic Cholangiography (PTC)
 | style="background: #F5F5F5; padding: 5px;" |
-*Ultrasound
+*Endoscopic ultrasound and MECP
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Pancreatitis]]
+![[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;" |Variable
@@ Line 1,068: / Line 1,359: @@
 *Primary [[cirrhosis]]
 *[[Primary sclerosing cholangitis]]
+*Cystic fibrosis
+*Autoimmune diseases
+| style="background: #F5F5F5; padding: 5px;" |
+* Alcohol abuse
+* Smoking
+* Genetic predisposition
 | style="background: #F5F5F5; padding: 5px;" |
-*No auscultatory finding associated with this [[disease]]
+* Tachypnea
+*Hypoxemia
+*Hypotension
+*Cullen's sign
+*Grey Turner sign
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Amylase]] levels
+*↑[[Amylase]] levels
-*[[Lipase]] levels
+*↑[[Lipase]] levels
-*Fecal tests
+*↑ALT
-*LFT's
+*↑ALP
-*Serum electrolytes
+*Leukocytosis
-*BUN and creatinine
-*Blood glucose, cholesterol, and triglycerides levels
-*CBC
-*C-reactive protein
 | style="background: #F5F5F5; padding: 5px;" |
 * T-wave inversion
@@ Line 1,086: / Line 1,383: @@
 * Q-waves
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Computed tomography|CT]]
+*[[Computed tomography|CT]]: focal or diffuse enlargement of the pancreas
-*[[Magnetic resonance imaging|MRI]]
+*[[Magnetic resonance imaging|MRI]]: Pancreatic enlargement
-*Transabdominal [[ultrasound]] ((TAUS)
-*Abdominal radiography
-*Endoscopic Retrograde Cholangiopancreatography
-*Magnetic Resonance Cholangiopancreatography
-*Image-Guided Aspiration and Drainage
 | style="background: #F5F5F5; padding: 5px;" |
 *CT Scan
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Hiatal Hernia|Sliding Hiatal Hernia]]
+![[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>
 | style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
 | style="background: #F5F5F5; padding: 5px;" |Variable
@@ Line 1,109: / Line 1,401: @@
 *[[Obstruction]]
 *Cameron [[Ulcer|ulcers]]
+*GERD
+*Dysphagia
+| style="background: #F5F5F5; padding: 5px;" |
+* Trauma
+* Iatrogenic
+* Congenital malformation
 | style="background: #F5F5F5; padding: 5px;" |
-*No auscultatory finding associated with this [[disease]]
+*Bowel sounds may be heard in the chest
 | style="background: #F5F5F5; padding: 5px;" |
-*No any specific laboratory test is done
+*Non specific
 | style="background: #F5F5F5; padding: 5px;" |
 *T wave inversion in anterior lead.
 | style="background: #F5F5F5; padding: 5px;" |
-*Chest radiograph
+*Barium swallow: At least three rugal folds traversing the diaphragm
-*[[Endoscopy]]
+*Upper endoscopy: A greater than 2-cm separation between the squamocolumnar junction and the diaphragmatic impression
-*[[Esophageal motility study|Manometry]]
+*High resolution manometry: The separation of the crural diaphragm from the lower esophageal sphincter (LES) by a pressure trough
-*Barium upper gastrointestinal series
 | style="background: #F5F5F5; padding: 5px;" |
-*Endoscopy
+*Upper endoscopy
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+*High resolution manometry (for smaller hernias)
+|- style="background: #DCDCDC; padding: 5px;" |
 | rowspan="6" |Musculoskeletal
-|[[Costochondritis|Costosternal syndromes (costochondritis)]]
+![[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
@@ Line 1,132: / Line 1,430: @@
 | 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;" |
-*Chest wall pain occurs  with a history of repeated minor trauma or unaccustomed activity (eg, painting, moving furniture)
+* Trauma
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Palpation]] of tender areas
+*Pain by palpation of tender areas
+*Maneuvers, such as the "crowing rooster" and horizontal arm flexion maneuver
 | style="background: #F5F5F5; padding: 5px;" |
-*No specific diagnostic test for this disease
+*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
+*CXR: To rule out fracture
-*MRI
 | style="background: #F5F5F5; padding: 5px;" |
-*No any gold standard test for this disease
+*Pain by palpation of tender areas
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|Lower rib pain syndromes
+!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
@@ Line 1,160: / Line 1,460: @@
 | 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;" |
-*No specific diagnostic test for this disease
+*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
+*CXR: To rule out fracture
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | ---
-*No any gold standard test for this disease
+|- style="background: #DCDCDC; padding: 5px;" |
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+!Sternalis syndrome
-|Sternalis syndrome
 | style="background: #F5F5F5; padding: 5px;" |Chronic
 | style="background: #F5F5F5; padding: 5px;" |Variable
@@ Line 1,186: / Line 1,487: @@
 *[[Heart|Cardiac]] diseases
 | style="background: #F5F5F5; padding: 5px;" |
-*On [[physical examination]] localized [[tenderness]] is found directly over the body of the sternum or overlying sternalis muscle
+* 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
@@ Line 1,193: / Line 1,498: @@
 *EKG is done to rule out other cardiovascular causes
 | style="background: #F5F5F5; padding: 5px;" |
-*[[X-rays|X-ray]]
+*[[X-rays|X-ray]] : To rule out fracture
-*Bone Scanning
 | style="background: #F5F5F5; padding: 5px;" |
-*No any gold standard test for this disease
+*Physical exam
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Tietze's syndrome]]
+![[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>
-|Acute
+| style="background: #F5F5F5; padding: 5px;" |Acute
-|Weeks
+| style="background: #F5F5F5; padding: 5px;" |Weeks
-|Pressure like pain over
+| style="background: #F5F5F5; padding: 5px;" |Pressure like pain over
 *Costosternal joint
 *[[Sternoclavicular articulation|Sternoclavicular]] joint
@@ Line 1,213: / Line 1,517: @@
 *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]]
@@ Line 1,221: / Line 1,530: @@
 *EKG is done to rule out other cardiovascular causes
 | style="background: #F5F5F5; padding: 5px;" |
-*[[X-rays|X-ray]]
+*[[X-rays|X-ray]]: To rule out fracture
-*MRI
 | style="background: #F5F5F5; padding: 5px;" |
 *Tests are done to rule out other diseases
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Xiphoidalgia]]
+![[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
@@ Line 1,239: / Line 1,547: @@
 | 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
@@ Line 1,247: / Line 1,558: @@
 *EKG is done to rule out other cardiovascular causes
 | style="background: #F5F5F5; padding: 5px;" |
-*X-ray
+*X-ray: To rule out fracture
 | style="background: #F5F5F5; padding: 5px;" |
 *Tests are done to rule out other diseases
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|Spontaneous [[sternoclavicular]] [[subluxation]]
+!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
@@ Line 1,262: / Line 1,573: @@
 *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
@@ Line 1,270: / Line 1,583: @@
 *EKG is done to rule out other cardiovascular causes
 | style="background: #F5F5F5; padding: 5px;" |
-*CT
+*[[X-rays|X-ray]]: Sclerosis of the medial clavicle
-*Esclerosis in [[X-rays|X-ray]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Esclerosis in [[X-rays|X-ray]]
+*X-ray
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! rowspan="3" |Differentials on the basis of Etiology
+! rowspan="3" |Differentials on the Basis of Etiology
 ! rowspan="3" |Disease
-! colspan="9" |Clinical manifestations
+! colspan="10" |Clinical Manifestations
 ! colspan="4" |Diagnosis
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 | colspan="8" |Symptoms
-! rowspan="2" |Physical exam
+| rowspan="2" |Risk Factors
-! rowspan="2" |Lab Findings
+! rowspan="2" |Physical Exam
+! rowspan="2" |Lab Findings
 ! rowspan="2" |EKG
 ! rowspan="2" |Imaging
-! rowspan="2" |Gold standard
+! rowspan="2" |Gold Standard
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 !Onset
 !Duration
-!Type of Pain
+!Quality of Pain
 !Cough
 !Fever
@@ Line 1,295: / Line 1,608: @@
 !Weight loss
 !Associated Features
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
 | rowspan="7" |Rheumatic
-|[[Fibromyalgia]]
+![[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
@@ Line 1,318: / Line 1,631: @@
 *[[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;" | ---
-*MRI
+| style="background: #F5F5F5; padding: 5px;" | ---
-| style="background: #F5F5F5; padding: 5px;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-*No any gold standard test is availble
+![[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: #DCDCDC; padding: 5px; text-align: center;" |
-|[[Rheumatoid arthritis]]
 | style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
 | style="background: #F5F5F5; padding: 5px;" |Years
@@ Line 1,346: / Line 1,660: @@
 *[[Carpal tunnel syndrome]]
 *[[Tarsal tunnel syndrome]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Old age
+* Smoking
+* Autoimmune conditions
 | style="background: #F5F5F5; padding: 5px;" |
 *Reduced grip strength
@@ Line 1,352: / Line 1,670: @@
 *Positive Rheumatic Factor
 *Anti-CCP body
+*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;" |
 *ECG is done rule out the heart failure as RA is one of the causes of heart failure
 | style="background: #F5F5F5; padding: 5px;" |
-*Plain film radiography of the affected joints
+*Plain film radiography: periarticular osteopenia, joint space narrowing, and bone erosions
-*MRI
+*MRI: Bone erosions
-*Ultrasonography
+*Ultrasonography: Degree of inflammation and the volume of inflamed tissue
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | ---
-*No any gold standard test for diagnosis of Rheumatoid Arthritis
+|- style="background: #DCDCDC; padding: 5px;" |
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+![[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>
-|[[Ankylosing spondylitis]]
 | style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
 | style="background: #F5F5F5; padding: 5px;" |Years
@@ Line 1,375: / Line 1,696: @@
 *Extra-articular joint involvements
 *[[Restrictive lung disease|Restrictive pulmonary disease]]
+*Acute coronary syndromes (ACS), strokes, venous thromboembolism, conduction abnormalities
+| style="background: #F5F5F5; padding: 5px;" |
+* Genetics (Monozygotic twins)
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Tenderness]] of the SI
@@ Line 1,380: / Line 1,704: @@
 *[[Schober's test|Schober test]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Complete blood count ([[Complete blood count|CBC]])
+*↑ESR
-*[[Erythrocyte sedimentation rate|Erythrocyte]] sedimetation rate ([[Erythrocyte sedimentation rate|ESR]])
+*↑CRP
-*[[Antigen]] HLA-27
+*↑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;" |
-*Computed tomography (CT)
+*Plain radiography: Erosions, ankylosis, changes in joint width, or sclerosis.
-*Magnetic resonance imaging (MRI)
+*Magnetic resonance imaging (MRI): Osteitis" or "bone marrow edema" (BME)
-*Power Doppler ultrasonography
 | style="background: #F5F5F5; padding: 5px;" |
 *Plain films of the sacroiliac joints
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Psoriatic arthritis]]
+![[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
@@ Line 1,412: / Line 1,737: @@
 *[[Tenosynovitis]]
 *[[Dactylitis]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Psoriasis
+* HLA-B*27 positive
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Dactylitis]] with sausage [[digits]]
-| style="background: #F5F5F5; padding: 5px;" |
+*Onycholysis
-*[[Serum]] complement
+*Pitting edema
-*Levels of Long Prentaxin 3 protein ([[PTX3]])
+*Ocular involvement
-*Increased levels of [[C-reactive protein|CRP]]
+| style="background: #F5F5F5; padding: 5px;" |Non specific
-*Erythrocyte sedimentation rate
-*Rheumatoid factor
-*Immunoglobulin
 | style="background: #F5F5F5; padding: 5px;" |
 *Longer PR interval
 | style="background: #F5F5F5; padding: 5px;" |
-*X-ray of the involved joints
+*X-ray: "pencil-in-cup" deformity, erosive changes and new bone formation, lysis of the terminal phalanges; fluffy periostitis
-*CT scanning
+*MRI: Detects articular, periarticular, and soft-tissue inflammation, enthesitis
-*MRI
-*Ultrasonography
 | style="background: #F5F5F5; padding: 5px;" |
-*No any gold standard test is available for this test
+*X-ray
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|Sternocostoclavicular [[hyperostosis]] (SAPHO syndrome)
+!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
@@ Line 1,443: / Line 1,766: @@
 *Palmoplantar [[pustulosis]] (PPP)
 | style="background: #F5F5F5; padding: 5px;" |
-*Depending on the type of [[joint]] affected
+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
-*High levels of alkaline [[phosphatase]]
+*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
+*Plain radiography: Hyperostotic changes (thickening of periosteum, cortex, and endosteum), sclerotic lesions, osteolysis, periosteal reaction, and osteoproliferation
-*Computed tomography
+*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
-*Magnetic resonance imaging
+|- style="background: #DCDCDC; padding: 5px;" |
-*Positron emission tomography
+![[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;" |
-*No any gold standard test is available for this disease
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
-|[[Systemic lupus erythematosus]]
 | style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
 | style="background: #F5F5F5; padding: 5px;" |Years
@@ Line 1,466: / Line 1,799: @@
 *[[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;" | +
@@ Line 1,474: / Line 1,807: @@
 *[[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]]
@@ Line 1,484: / Line 1,821: @@
 *Elevation of [[Autoantibody|autoantibodies]] ([[Antinuclear antibodies|ANA]], [[Anti-dsDNA antibody|anti-dsDNA]], [[Anti-SM antibody|anti-SM]], [[Antiphospholipid antibodies|antiphospholipid]])
 *[[Complement]] levels decreased
-*Serum creatinine
+*Anemia
-*Urinalysis with microscopy
-*Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
-*Liver function tests
-*Creatine kinase assay
-*Spot protein/spot creatinine ratio
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Sinus tachycardia]], [[ST segment changes]], and [[Ventricular arrhythmias|ventricular conduction disturbances]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Joint radiography
+*Related to specific organ involvent
-*Chest X-ray
-*CT Scan
-*MRI
-*Echocardiography
-*Arthrocentesis
-*Lumbar puncture
 | style="background: #F5F5F5; padding: 5px;" |
 *Anti-dsDNA antibody test
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Relapsing polychondritis]]
+![[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
+| style="background: #F5F5F5; padding: 5px;" |Intermittent pain in:
 *[[Tissue (biology)|Tissues]] that cover the end of the [[Joint|joints]]
 *[[Cartilage]] of costal rib
@@ Line 1,519: / Line 1,845: @@
 *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
-*[[Biopsy]]
+*Anti-type II collagen antibodies
-*Complete blood cell count (CBC) with differential
+*Antineutrophil cytoplasmic antibodies
-*Metabolic panel
-*Serum creatinine
-*Liver transaminase and serum alkaline phosphatase studies
-*Urinalysis dipstick and microscopic evaluation of sediment
-*Cryoglobulins
-*Viral hepatitis panel
-*Antinuclear antibody (ANA)
-*Antineutrophil cytoplasmic antibody (ANCA)
 | style="background: #F5F5F5; padding: 5px;" |
 * ECG is done to rule out the cardiovascular complications of this disease
 | style="background: #F5F5F5; padding: 5px;" |
-*Chest radiography
+*Non specific
-*Spiral CT scanning
+*Related to specific organ involvent
-*FDG-PET/CT
-*MRI
-*Posteroanterior and lateral dye contrast pharyngotracheogram
-*Scintigraphy
 | style="background: #F5F5F5; padding: 5px;" |
 *No gold standard test for this disease
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
 |Psychiatric
-|[[Panic attack]]/ Disorder
+![[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
@@ Line 1,559: / Line 1,875: @@
 *[[Agoraphobia]]
 | style="background: #F5F5F5; padding: 5px;" |
-*Complete [[psychiatric]] and [[Neurological|neurologic examination]] is needed in these [[patients]]
+*Psychiatric disorders
+| style="background: #F5F5F5; padding: 5px;" |
+*Anxious
+*Tachypneic
 | style="background: #F5F5F5; padding: 5px;" |
 *Thyroid function tests
@@ Line 1,568: / Line 1,887: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *No any specific radiographic test is done
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | ---
-*No gold standard test for panic attack
+|- style="background: #DCDCDC; padding: 5px;" |
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| rowspan="2" |
-| rowspan="2" |Others
+Others
-|Substance abuse
+!Substance abuse
-([[Cocaine abuse|Cocaine]])
+([[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;" | +
@@ Line 1,586: / Line 1,905: @@
 *[[Nausea and vomiting|Nausea]]
 *[[Palpitation|Palpitations]]
+| style="background: #F5F5F5; padding: 5px;" |
+*Psychiatric disorders
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Signs]] of [[injection]] [[drug use]]
@@ Line 1,598: / Line 1,919: @@
 **Arrhythmias
 **Cardiac conduction abnormalities
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | ---
-*Brain CT scan
 | style="background: #F5F5F5; padding: 5px;" |
 *Gold standard test depends on the type of substance is abuse
-|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|- style="background: #DCDCDC; padding: 5px;" |
-|[[Herpes Zoster]]
+![[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
@@ Line 1,616: / Line 1,936: @@
 | 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;" |
-*Nerve test
+*Viral culture
-*[[Blood test]]
+*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)
+*Magnetic resonance imaging (MRI): To rule out encephalitis
 | style="background: #F5F5F5; padding: 5px;" |
 *Viral tissue culture
 |}
+<small/><small/>
 == References ==