Atypical Chest Pain

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of chest pain

Onset was ‍gradualsuddentraumatic, started ‍on exertionat rest, ‍whileafter ‍

Location is ‍retrosternal

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍pressureheaviness

Pattern ‍persistentintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍none, ‍with deep breath, ‍with lying on back

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍lower extremity edema, ‍rightleftsymmetrical

‍palpitations

‍syncope

‍dizziness

‍fatigue

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diaphoresis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍hemoptysis



Cardiovascular risk factors:

‍tobacco use

‍high cholesterol

‍high blood pressure

‍sedentary lifestyle

‍obesity

‍diabetes

‍previous myocardial infarction

‍family history of heart disease



Pulmonary embolism risk factors:

‍age > 50

‍heart rate > 100

‍sat < 95%

‍unilateral leg swelling

‍hemoptysis

‍surgery or trauma < weeks ago

‍prior PE DVT

‍hormone oestrogenic use



Other factors:

‍gastroesophageal reflux disease

‍anxiety disorder





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Musculoskeletal chest pain ‍likelysuspectedpossible

DDx: acute coronary syndrome, myocardial infarction, angina pectoris, atypical chest pain, pericarditis, musculoskeletal pain, costochondritis, GERD, pulmonary embolism, aortic dissection, pneumothorax, esophageal spasm, esophageal rupture, pneumonia, rib fracture, anxiety/panic disorder, herpes zoster, gallbladder disease, peptic ulcer disease





PLAN:

Investigations:

- ECG

- Chest X-ray

- Blood work: ‍troponin, ‍d-dimers, ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍albumin, ‍lipase, ‍CRP

- Stress test

- CT angio of the chest

- Cardiac catheterization

Treatments:

- Aspirin 80mg 4 tablets po STAT then 1 tablet daily

- Nitroglycerin 0.4mg sublingual q 5 min up to 3 doses

- ‍Analgesics

Further care:

- Referral to cardiologist

- Referral to ER

- Follow up if not better or worsen