CHEST PAIN

HISTORY ????..

•SITE•ONSET•CHARACTER•SEVERITY•DURATION•RADIATION•AGGRAVATING FACTORS•RELIEVING FACTORS•ASSOCIATED SYMPTOMS

SITE

RETROSTERNAL PERIPHERAL

RETROSTERNAL•CARDIAC-ANGINA, MI,MYOCARDITIS,PERICARDITIS, MVP

•MEDIASTINAL-TRACHEITIS,MALIGNANCY

•AORTIC-DISSECTION,ANEURYSM

•ESOPHAGEAL-ESOPHAGITIS,SPASM,MALLORY WEISS SYNDROME

•ANXIETY/EMOTION

PERIPHERALLUNG/PLEURAL-PNEUMOTHORAX,INFARCT.

MALIGNANCY

MUSCULOSKELETAL-RIB#,MUSCLE INJURY,OSTEOARTHRITIS,OSTEOCHONDRITIS

BREAST DISORDERS

NEURALGIC-IVDP,HERPES

ANXIETY

ONSETSUDDEN RETROSTERNAL-

MI,PNEUMOTHORAX,PULM. EMBOLISM,ESOPHAG. RUPTURE

PERIPHERAL-PNEUMOTHORAX,PE

GRADUALLY ON EXERTION-ANGINA

AFTER VOMITING-ESOPHAGEAL RUPTURE

CONSTANT-PERICARDITIS,MUSCULOSKELETAL ,GI

OCCURING WHEN ?DURATION?

ON EXERTION-CARDIAC PAIN

ON FOOD INTAKE-ESOPHAGEAL

ANGINA <20min

MI >30min

CHARACTER & SEVERITYCONSTRICTING-

CARDIAC,ESOPHAGEAL SPASM

STABBING-PLEURAL,MUSC. SK

LEVINE’S SIGN

AGGRAVATING FACTORSANGINA-

EXERTION,EMOTION,COLD,HEAVY MEAL

PERICARDITIC/PLEURITICSWALLOWING,MOVEMENT,COU

GH’G,RESPIRATIONMUSCULOSKELETALAGGRAVATED WITH MOVEMENT

RELIEVING FACTORSANGINA-REST

ESOPHAGITIS-FOOD,ANTACID,MILK

PLEURITIC-HOLDING BREATH

ASSOCIATED SYMPTOMS

BREATHLESSNESS-MI,PNEUMOTHORAX,PE

FEVER-PERICARDITIS,PLEURITIS

DYSPHAGIA-ESOPHAGEAL D/S

PARAESTHESIA,HEADACHE,INSOMN. -ANXIETYPAIN &HEMATEMESIS-

MWS,ESOPH.RUPTURE

CARDIAC PAIN

CENTRAL, DIFFUSECONSTICTINGRADIATION EXERTION,EMOTION

REST, NITRATESBREATHLESSNESS,AUT

DISTURBANCES

NON CARDIAC PAIN

PERIPH,LOCALIZEDSTABBINGPRESENT/ ABSENTPOSTURE, MVMTNOT RELIEVEDSYSTEM RELATED

PAST HISTORYDIABETES MELLITUSVASCULITISHYPERTENSIONSTEROIDS,OCPSPROLONGED BED REST/SURGERYTRAUMA/ASSAULT

PERSONAL HISTORYDIET

SMOKING

ALCOHOLISM

FAMILY HISTORYCADHYPERTENSIONDIABETES MELLITUSDYSLIPIDAEMIACOLLAGEN VASCULAR D/SCONGENITAL HEART D/S

TREATMENT HISTORYNSAIDS,ASPIRIN

STEROIDS

OCPs

CHEST PAIN

CARDIAC NON CARDIAC

ISCHAEMIC NON-ISCHAEMIC

ANGINA MI MYOCARDITIS PERICARDITIS MVP

THANK YOU….