15. CHEST PAIN CLASSIFICATION FROM CLINICAL VIEW POINT: RECURRENT OFTEN PAROXYSMAL MILD OR MODERATE ANGINA MUSCULOSKELETAL PAINS SEVERE PROLONGED ASSOCIATED WITH CLINICAL EVIDENCE OF ACUTE SERIOUS ILLNESS 1 2
32. ISCHEMIC CARDIAC PAIN NON-CARDIAC PAIN V/S LOCATION CENTRAL, DIFFUSE PERIPHERAL LOCALIZED RADIATION JAW/NECK/SHOULDER/ OCCASIONALLY BACK OTHER OR NO RADIATION CHARACTER TIGHT SQUEEZING CHOKING SHARP STABBING CATCHING PRECIPITATION EXERTION EMOTION SPONTANEOUS NOT RELATED TO EXERTION PROVOKED BY POSTURE, RESPIRATION OR PALPATION RELIEVING FACTORS REST NITRATES NOT RELIEVED BY REST SLOW OR NO RESPONSE BY NITRATES ASSOCIATED FEATURES BREATHLESSNESS RESP; GIT,LOCOMOTOR, OR PSYCHOLOGICAL
In spite of the many innovations over the years and the huge influx of technology into medicine and cardiology, the evaluation of acute chest pain remains an important and challenging task for the physician today. It leads to more than 5 million ER visits annually and more than 8 billion dollars in hospitalization costs each year. And while on one hand less than a third of patients with chest pain are found to have a cardiac etiology, a not insignificant number of patients discharged from the ED turn out to have unrecognized acute MI
So our goal, then, is minimize the cost and hospitalization of patients with chest pain of benign etiology, but to rapidly and accurately recognize and treat those with true acute coronary syndromes.
There are many ways chest pain can be approached, ranging from use of clinical clues, cookbook algorithms, computer guided algorithms, and finally, the use of dedicated chest pain centers. Each approach will now be reviewed.
Lecture Notes On initial examination, Q-wave AMI may masquerade as another ACS (eg, unstable angina or non–Q-wave MI) or vice versa. Distinguishing AMI from another possible ACS is important as fibrinolytic therapy has not been proved beneficial for other forms of ACS and entails a bleeding risk.