Chest Pain

Chest Pain James Nixon, MD Assistant Professor Internal Medicine and Pediatrics

What would be the differential for her chest pain?

Chest Pain ,[object Object],[object Object],[object Object],[object Object]

What are risk factors you would ask about for cardiac etiologies for chest pain? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What characteristics of the chest pain might make you more concerned for cardiac chest pain? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Any exam findings that might help distinguish cardiac from non cardiac chest pain? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Any tests that might help that you can do in the ER? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Any tests that might help that you can do in the ER? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Fesmire FM; Percy RF; Bardoner JB; Wharton DR; Calhoun FB. Serial creatinine kinase (CK) MB testing during the emergency department evaluation of chest pain: utility of a 2-hour delta CK-MB of +1.6ng/ml. Am Heart J 1998 Aug;136(2):237-44

Any tests that might help that you can do in the ER? ,[object Object]

Labs ,[object Object],[object Object]

What is his pre-test probability for having coronary artery disease?

What tests could help determine if this man truly does have coronary artery disease causing his symptoms?

Likelihood Ratio Nomogram EST LR+ 11 LR- 0.23

Likelihood Ratio Nomogram Exercise Echo LR+ 7.4 LR- 0.21

Case #3 ,[object Object],[object Object],[object Object],[object Object],[object Object]

What exam findings might you look for? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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[object Object],[object Object],[object Object],[object Object],Von kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Archives of Internal Medicine 2000;160:2977.

What tests could you do and why? ,[object Object],[object Object],[object Object],[object Object],[object Object]

What are the treatments for the most likely diagnoses?

Case #4 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What is your prioritized differential? ( What is most likely and what would concern you the most?)

What questions would help you refine your differential?

What would you look for on physical exam? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What test would you do to help refine your diagnosis? ,[object Object],[object Object],[object Object]

Case #5 ,[object Object],[object Object],[object Object],[object Object]

Chest Pain

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Chest Pain