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Chest pain or discomfort

Chest pain or discomfort. Etiology. 1-Cardiac 2-Intrathorcic Structuers aorta – PA – Bronchopulmonary tract- pleura – Mediastinum – Esophagus - diaphragm 3-Neck Structure 4-Thoracic wall ( Breast , ribs - spine nerve – spinal cord - thoracic cage )

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Chest pain or discomfort

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  1. Chest pain or discomfort

  2. Etiology 1-Cardiac 2-Intrathorcic Structuers aorta – PA – Bronchopulmonary tract- pleura – Mediastinum – Esophagus - diaphragm 3-Neck Structure 4-Thoracic wall ( Breast , ribs - spine nerve – spinal cord - thoracic cage ) 5-Subdiaphragmatic organ (Stomach – duodenum – pancreas -gull bladder )

  3. Common Cause 1-Anxiety 2-Fibromyaligia 3-Gi – tract ( esophagus – Stomach deudenum – gall bladder – colon pancreas – Spleen – Abcess ) 4-Pulmonary ( PTE – Pnumothorax – PH – Pleural – Pnumonia –Bronchitis ) 5-MVP

  4. Approach 1- History 2- Physical exam 3- ECG 4- Other exam

  5. History of Present Illness (HPI) The following 8 elements are recognized: Location:low back pain Quality:describes discomfort as: pressure Severity:severity of condition is worsening Duration:condition has existed for one month Timing:pain is worse in the morning Context:pain occurred after lifting baby Modifying Factor: sociated signs and symptoms:pain radiating to the arm andshortness of breath

  6. History 1- PQRST precipitating factor 2-Quality 3-Radiation – relief Region repitation ( frequency ) 4-Severity , Site 5-Timing ( duration)

  7. Quality 1- Burning 2-Sqeezing 3-Pressing 4-Bursting 5-Knif like 6-Pluretic 7-With movement 8-Dyspnea 9-Stherotype

  8. Location 1- Precordial 2-Substernal 3-Superficial 4-Deep 5-Lochalized 6-Area 7-Submammary 8-Right Lower chest

  9. Precipitafing Factor 1- Exertion ( Special with emotion ) Walk up – Cold _ After Meal 2-Strong emotional stress 3-Smoking 4- Prinzmetal Angina 5- Breathing 6- Womiting 7- Rest 8- Bending 9- Body movement

  10. Duration - 2 – 10 min - < 2 min - >10 min - Proloned

  11. IHD 1- Asymptomatic 2- Nonanginal CP 3- Athypicak Angina 4- Thypical Angina 6- MI 7- CHF 8- SCD

  12. Angina Equivalent 1-Dyspnea 2-Unusual Location ( Left arm , Lower Jaw , teeth , neck , Shoulders) 3-Bleching 4-Nausea 5-Indigestion 6-Dizziness 7-Diaphouesis

  13. Musculoskeletal 1-Cervical Spine 2-Thoracic Spine 3-Myositis 4-Synovitis 5-Artheritis 6-Teitze Syndrome 7-Herpes Zoster

  14. Review of Systems (ROS) Patient has the following complaints: Constitutional: fevers, chills and night sweats Eyes: she also complains of itchy eyes ENT: nasal congestion, drainage from ear Respiratory: she reports shortness of breath Cardiovascular: left sided chest pain Gastrointestinal: diarrhea, constipation, abdominal pain Genitourinary: blood in urine Allergies : allergic to cypress, pine nuts, peanuts “Remainder of the review of systems are negative”

  15. ROS For a complete ROS ten organ systems must be reviewed The attending physician may use“remainder of the review of systems are negative”when (2) pertinent positives and/or negatives are documented In absence of such a notation, all systems must be documented Applies to CPT codes: 99222, 99223, 99254, 99255 which require 10 + ROS

  16. ENd

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