Chest Pain and IHD PDF

# Diagnosis of Chest Pain ## Acute Chest Pain * **Coronary Syndrome** * **Causes:** Sudden occlusion → Death ## Causes of Acute Chest Pain: 1. **Acute Coronary Syndrome (Acute Occlusion):** * Acute retrosternal Compressing / Burning / Radiate Heaviness associated with sweating & se...

# Diagnosis of Chest Pain ## Acute Chest Pain * **Coronary Syndrome** * **Causes:** Sudden occlusion → Death ## Causes of Acute Chest Pain: 1. **Acute Coronary Syndrome (Acute Occlusion):** * Acute retrosternal Compressing / Burning / Radiate Heaviness associated with sweating & sensory of doom * **Chronic Angina (Chronic Coronary Mismatch):** * **Excercises:** Partially Occlusion * **Rest:** 2. **Acute Aortic Syndrome (Dissection)** * **Intimal Ulcer:** * **Type A:** Dissection in descending aorta * **Type B:** Dissection below left subclavin artery * **Echo:** Beats in aortic aneurysm * **Rupture Aortic Syndrome:** Aneurysm 3. **Acute Tearing/Stabbing Syndrome (Pain):** * Aortic Ulcer Perforating 4. **Pericardium** * **Inflammation:** Pericarditis Pain * Chest Movement → Chest Pain Burning * **Deep Inspiration:** ↑ Pain * **Common ECG:** * **Diffuse CT Segment:** Happy Face * **Inferior Wall Elevation:** ↑ * **Lateral Wall Elevation:** ↑ * **Anterior Wall Elevation:** ↑ * **Treatment:** Chol-She-Cin ## Acute Inflammation: Pleura * Deep Inspiration → with Chest Movement Pain ## Eososphageal Spasm * With Eating * **Pericarditis:** * Deep Inspiration: ↑ Pain * **ECG:** * Diffuse ST Segment Deviation * Happy Face * **Profine:** * Colchicine ## Pleurisy * **Pneumonia:** Deep Inspiration & Chest Movement Pain # Chronic Heart ## Ischemic Disease * **Supply Deficiency:** Ischemia * **Demand Increase:** (mcor) * **Coronary Stenosis due to Atherosclerosis** * **Embolus** * **Non Atherosclerosis Vasculitis** ### Manifestation: 1. **Typical Chest Pain:** * Retrosternal Compressing (Stretching) * **Excercise Stress:** ↑ * **Rest:** ↓ * **Refered Pain:** Referred left arm/shoulder/jaw / left side back 2. **Atypical Chest Pain:** * **Criteria:** Ischemic ### Atypical Presentation Non Chest Pain: 1. **Palpitation** 2. **Angor Anim (Sensory)** 3. **Dyspnea:** * Angina Equivalent * Death 4. **Gastric Pain** ## Necrosis Changes * **Acute MI:** Inj 2 * **ST:** Non ST Elevation * **Repo:** Don't forget to hydrate * **Aspirin:** Don't let the patient die * **Started Depression:** * Severe Pain * Sudden Chest * Cardiogenic Shock ### Chronic: * **Acute Attac:** * **MI:** chest pain * **Unstable Angina:** * Severity - ### Chronic: * **MI:** Unstable Angina * **Enzymes:** * **Duration:** * **More severe:** * **Severe During Rest:** * **Severe Chest Pain:** ## Investigation 1. **Lab** * **Troponin/CKMP** * **Lipid Profile** * **Atherosclerosis** * **ST** * **Elevation** * **Depression** * **Echo** * **ECG** * **Wall Motion** * **Stenosis** * **CT** * **Cardiac Catheterization** * **Coronary** * **Angio** ## Treatment 1. **Antiplatelet** * **Asprin** * **Clopidoprin** 2. **Statin** * **Lipid** 3. **Chornary Dilator** 4. **Bronche** * **Thrombolytic** * **Beta Blocker** * **Disk Factor**