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CHEST PAIN. David Griffen , MD, PhD Southern Illinois School of Medicine. Chest Pain. Acute Coronary Syndrome Aortic Dissection Pulmonary Embolus Pneumothorax Boerhaave syndrome Myocarditis Pericarditis Trauma Peptic ulcer, cholecystitis , pancreatitis Pleurisy GERD
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CHEST PAIN David Griffen, MD, PhD Southern Illinois School of Medicine
Chest Pain • Acute Coronary Syndrome • Aortic Dissection • Pulmonary Embolus • Pneumothorax • Boerhaave syndrome • Myocarditis • Pericarditis • Trauma • Peptic ulcer, cholecystitis, pancreatitis • Pleurisy • GERD • Herpes Zoster • Hyperventilation • Costochondral pain • Chest wall strain
Chest Pain • Acute Coronary Syndrome • Aortic Dissection • Pulmonary Embolus • Pneumothorax • Boerhaave syndrome • Myocarditis • Pericarditis
Chest Pain • Acute Coronary Syndrome • Aortic Dissection • Pulmonary Embolus • Pneumothorax • Boerhaave syndrome • Myocarditis • Pericarditis
Patient #1 • This is a 47 year old male with a history of hypertension presenting to the ED with complaint of chest pain beginning 11 hours prior to arrival. • The pain is now better but was located in the lower chest and did not radiate. It has been intermittent through the day, at times associated with some mild diaphoresis but no other symptoms.
Patient #1 • The patient did have one episode of transient paresthesias of her left hand and had a brief episode of paresthesia of his left leg without any weakness. • He stated that this rapidly resolved when she “walked it off”. • No extremity weakness. • Other than the hypertension, PMH is unremarkable.
Patient #1 • EKG with rate of 64, sinus rhythm, no diagnostic ST or T wave changes • Laboratory testing negative including cardiac markers. • The patient had some epigastric discomfort on palpation which was completely relieved with Mylanta and Viscous xylocine. • The patient was hypertensive in the ED. • As a precaution he was placed in the chest pain protocol to have myocardial infarction ruled out and a stress dobutamine echocardiogram performed.
Patient #1 • Four hours after arrival, the patient complained of chest and epigastric pain. A repeat EKG showed marked bradycardia at 45. The patient was taken out of the chest pain protocol and Cardiology consulted. The patient’s pain became more intense and moved to the upper abdomen, a CT scan of the abdomen with IV and oral contrast was obtained.
Patient #1 • The CT showed a dissection of the lower thoracic and abdominal aorta with extension of the dissection into the origin of the superior mesenteric artery and with extensive dissection into the left common iliac artery.
