CHESTPAIN - CHEST PAIN VETA ZIKOS CHEST PAIN Accounts for 5 of all ED visits per year Differential diagnosis is extensive CHEST PAIN ANATOMY

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Unformatted text preview: CHEST PAIN VETA ZIKOS CHEST PAIN Accounts for 5% of all ED visits per year Differential diagnosis is extensive CHEST PAIN ANATOMY DIFFERENTIAL DIAGNOSIS BRIEF OVERVIEW OF DISEASE PROCESSES CAUSING CHEST PAIN APPROACH TO CHEST PAIN ANATOMY In devising a differential diagnosis for chest pain, it becomes essential to review the anatomy of the thorax. The various components of the thorax can all be responsible for producing chest pain ANATOMY SKIN MUSCLES ANATOMY BONES ANATOMY PULMONARY SYSTEM ANATOMY HEART ANATOMY VASCULATURE AND GI SYSTEM AORTA AND ESOPHAGUS DIFFERENTIAL DIAGNOSIS OF CHEST PAIN CHEST WALL PAIN PULMONARY CAUSES CARDIAC CAUSES VASCULAR CAUSES GI CAUSES OTHER (PSYCHOGENIC CAUSES) DDX: CHEST PAIN CHEST WALL PAIN-Skin and sensory nerves- Musculoskeletal system DDx: CHEST PAIN CHEST WALL PAIN-Skin and sensory nerves-Herpes Zoster- Musculoskeletal system- Isolated Musculoskeletal Chest Pain Syndrome *Costochondritis *Xiphoidalgia *Precordial Catch Syndrome *Rib Fractures- Rheumatic and Systemic Diseases causing chest wall pain DDX: CHEST PAIN PULMONARY CAUSES- Pulmonary Embolism- Pneumonia- Pneumothorax/ Tension PTX- Pleuritis/Serositis- Sarcoidosis- Asthma/COPD- Lung cancer (rare presentation) DDx: CHEST PAIN CARDIAC CAUSES- Coronary Heart Disease * Myocardial Ischemia *Unstable Angina *Angina- Valvular Heart Disease * Mitral Valve Prolapse *Aortic Stenosis- Pericarditis/Myocarditis DDX: CHEST PAIN Vascular Causes:-Aortic Dissection DDX: CHEST PAIN GI CAUSES-ESOPHAGEAL * Reflux * Esophagitis * Rupture (Boerhaave Syndrome) * Spasm/Motility Disorder/Foreign Body Secondary to Stricture/Web/Etc- OTHER * Consider Pain referred from PUD, Biliary Disease, or Pancreatitis DDX: CHEST PAIN PSYCHIATRIC- PANIC DISORDER- ANXIETY- DEPRESSION- SOMATOFORM DISORDERS CHEST PAIN BRIEF OVERVIEW OF DISEASE PROCESSES CAUSING CHEST PAIN CHEST WALL PAIN . CHEST WALL PAIN HERPES ZOSTER-Reactivation of Herpes Varicellae- Immunocompromised patients often at risk for reactivation. - 60% of zoster infections involve the trunk- Pain may precede rash HERPES ZOSTER Clusters of vesicles (with clear or purulent fluid) grouped on an erythematous base. Lesions eventually rupture and crust. Dermatomal distribution. Usually unilateral involvement that halts at midline HERPES ZOSTER TREATMENT: * Antivirals: reduce duration of symptoms. May also reduce incidence of postherpatic neuralgia. * +/- corticosteroids: May reduce inflammation * Analgesia POSTHERPETIC NEURALGIA: * May follow course of acute zoster * Shooting, sharp pain. * Hyperesthesia in involved dermatome * Treatment: simple analgesics, antidepressants, gabapentin CHEST WALL PAIN Musculoskeletal Pain- Usually localized, sharp, positional- Pain often reproducible by palpation- At times reproduced by turning or arm movement- May elicit history of repetitive or unaccustomed activity involving trunk/arms- Rheumatic diseases will cause musculoskeletal pain via thoracic joint involvement MUSCULOSKELETAL PAIN...
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This note was uploaded on 01/11/2012 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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CHESTPAIN - CHEST PAIN VETA ZIKOS CHEST PAIN Accounts for 5 of all ED visits per year Differential diagnosis is extensive CHEST PAIN ANATOMY

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