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Thread: Chest Pain

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    Default Chest Pain

    Differential Diagnosis of Chest Pain



    A patient with chest pain poses one of the most complicated diagnostic challenges. The differential diagnosis is extensive and includes diagnoses that can be imminently life-threatening. The initial pivotal points are the acuity of onset of the pain and the presence of vital sign abnormalities. Later in evaluation, the presence of ECG or chest film abnormalities, symptoms consistent with aortic dissection, and the presence or absence of pleuritic pain (pain that worsens with inspiration) are important pivotal points.

    The differential diagnosis of chest pain is best remembered using an anatomic approach. Consideration needs to be given to the structures from the skin to the internal organs. The differential below is organized anatomically.

    • Skin: Herpes zoster
    • Breast
      • Fibroadenomas
      • Mastitis
      • Gynecomastia

    • Musculoskeletal
      • Costochondritis
      • Precordial catch syndrome
      • Pectoral muscle strain
      • Rib fracture
      • Cervical or thoracic spondylosis (C4-T6)
      • Myositis

    • Esophageal
      • Spasm
      • Rupture
      • Esophagitis
        • Reflux
        • Medication-related

      • Neoplasm

    • Gastrointestinal
      • Peptic ulcer disease
      • Gallbladder disease
      • Liver abscess
      • Subdiaphragmatic abscess
      • Pancreatitis

    • Pulmonary
      • Pleura
        • Pleural effusion
        • Pneumonia
        • Neoplasm
        • Viral infections
        • Pneumothorax

      • Lung
        • Neoplasm
        • Pneumonia

      • Pulmonary vasculature
        • Pulmonary embolism
        • Pulmonary hypertension

    • Cardiac
      • Pericarditis
      • Myocarditis
      • Myocardial ischemia

    • Vascular: Thoracic aortic aneurysm or aortic dissection
    • Mediastinal structures
      • Lymphoma
      • Thymoma

    • Psychiatric


    Chest Pain-screen-shot-2017-04-09-at-7-27-50-pm-png
    Last edited by admin; Tue 23rd May '17 at 9:59pm.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease. Chengdu, Sichuan, China.

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