While we have standard approaches to patients with specific complaints. It is important to also think of the various issues that mat be causing these complaints and not to get tunnel vision. Here are some differentials you should think about for those patients complaining of chest pain. I have also added a few things you should consider during your assessment.
Chest Pain Differentials
- Angina Aortic dissection
- Cocaine abuse
- Esophageal spasm
- Marijuana abuse
- Musculoskeletal pain
- Myocardial infarction
- Pulmonary embolus
- Rib contusion/fracture
- Sickle cell anemia crisis
If you are not sure why you should consider these causes of chest pain. Get that textbook open and see why.
I also suggest you consider the following during your assessments.
- If you have a patient loser than 30-years complaining of chest pain or any patient with a recent history of cocaine or crack use with chest pain you should be consider them at risk for cardiac disease
- These patients should also have a 12-lead ECG performed
- A 12-lead ECG that appears normal or interpreted as normal should never be used to convince a patient that their condition is stable. In fact more than 50% of acute myocardial infarctions will present with a normal ECG
- Pain from an aortic dissection may be described as ripping or tearing in nature
- In this context, you should consider including bilateral blood pressures along with upper and lower extremity pulse assessments during your assessment
- Patients at risk for pulmonary embolism (patients on oral contraceptives, prolonged immobilization, recent surgery, prior history of clotting disorders) may show signs of tachycardia and tachypnea
- ? Patients with PE may also have an ECG reflecting incomplete RBBB
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