er chest pain
TRANSCRIPT
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CHEST PAINCHEST PAIN
BYBY
DR. OMAIMA FATHYDR. OMAIMA FATHY
E.R. SPECIALISTE.R. SPECIALIST
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Chest painChest pain
Common complaint of acute care settings.Common complaint of acute care settings.
5% of ED visits.5% of ED visits.
3-10% discharged inappropriately.3-10% discharged inappropriately.
Differentiating between ischemic and non-Differentiating between ischemic and non-
ischemic causes can be difficult.ischemic causes can be difficult.
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Severity of Chest pain correlatesSeverity of Chest pain correlates
with gravity of its causewith gravity of its cause
WRONGWRONG
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PathophysiologyPathophysiology
Alternate pain fibers are classified into 2 broad categoriesAlternate pain fibers are classified into 2 broad categories Visceral &Visceral &Somatic.Somatic.
Pain from visceral fibers is more difficult to describe & is preciselyPain from visceral fibers is more difficult to describe & is preciselylocalized.localized.
Those experiencing visceral pain are more likely to use terms such asThose experiencing visceral pain are more likely to use terms such asdiscomfortdiscomfort,, heaviness,heaviness, or aching.or aching.
Visceral pain fibers are found in internal organs such as blood vessels.Visceral pain fibers are found in internal organs such as blood vessels.
Further, patients frequently misinterpret the origin of visceral pain becauseFurther, patients frequently misinterpret the origin of visceral pain becauseit is the esophagus, and the visceral pleura.it is the esophagus, and the visceral pleura.
The dermis and parietal pleura are innervated by somatic pain fibers.The dermis and parietal pleura are innervated by somatic pain fibers.
pain from somatic fibers is usually easily described, precisely located, oftenpain from somatic fibers is usually easily described, precisely located, oftenreferred to a different area of the body corresponding to an adjacentreferred to a different area of the body corresponding to an adjacentsomatic nerve experienced as a sharp sensation.somatic nerve experienced as a sharp sensation.
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Causes of chest painCauses of chest painCardiacCardiac
VascularVascular
PulmonaryPulmonary
GastrointestinalGastrointestinal
MusculoskeletalMusculoskeletal
OthersOthers
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Cardiac causesCardiac causes
Coronary artery diseaseCoronary artery disease
Aortic stenosisAortic stenosis
HypertrophicHypertrophic
cardiomyopathycardiomyopathy
PericarditisPericarditis
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Vascular causesVascular causes
Aortic dissectionAortic dissection
Pulmonary embolismPulmonary embolism
Pulmonary hypertensionPulmonary hypertension
Right ventricular strainRight ventricular strain
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Pulmonary causesPulmonary causes
Pleuritis or pneumoniaPleuritis or pneumonia
TracheobronchitisTracheobronchitis
PneumothoraxPneumothorax
TumorTumor
Mediastinitis or mediasinal emphysemaMediastinitis or mediasinal emphysema
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Gastrointestinal causesGastrointestinal causes
Eosophageal perforationEosophageal perforation
Eosophageal refluxEosophageal reflux
Eosophageal spasmEosophageal spasm
Mallory-Wiss tearMallory-Wiss tear
Peptic ulcer diseasePeptic ulcer disease
Biliary diseaseBiliary disease
PancreatitisPancreatitis
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Musculoskeletal causesMusculoskeletal causes
Cervical disk diseaseCervical disk disease
Arthritis of the shoulder or spineArthritis of the shoulder or spine
CostochondritisCostochondritis
Intercostal muscle crampsIntercostal muscle cramps
Subacromial bursitisSubacromial bursitis
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OthersOthers
Disorders of the breastDisorders of the breast
Chest wall tumorsChest wall tumors
Herpes zosterHerpes zoster
EmotionalEmotional
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CADCAD
Stable angina pectorisStable angina pectoris
Unstable angina pectorisUnstable angina pectoris
Decubitus anginaDecubitus angina
Prinzmetals (variant) anginaPrinzmetals (variant) angina
Cardiac syndrome XCardiac syndrome X
Acute myocardial infarctionAcute myocardial infarction
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Stable anginaStable angina
Chest pain is described as heaviness, tightness, pressure,Chest pain is described as heaviness, tightness, pressure,squeezing, or choking. Lasts for 1-5 minutes.squeezing, or choking. Lasts for 1-5 minutes.
Typically pain is central/retrosternal and may radiate to, leftTypically pain is central/retrosternal and may radiate to, left
shoulder, both arms, back, neck, jaw, teeth, orshoulder, both arms, back, neck, jaw, teeth, orepigastrium.epigastrium.
Episodes are typically caused by exertion or emotion and areEpisodes are typically caused by exertion or emotion and arerelieved by rest or sublingual nitrates.relieved by rest or sublingual nitrates.
Angina may be precipitated by unfamiliar tasks, a heavy mealAngina may be precipitated by unfamiliar tasks, a heavy mealor exposure to cold.or exposure to cold.
May be accompanied by light-headedness, palpitations,May be accompanied by light-headedness, palpitations,diaphoresis , dyspnea, nausea, or vomiting.diaphoresis , dyspnea, nausea, or vomiting.
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THANK YOUTHANK YOU