Differential Diagnosis PDF

Differential Diagnosis A wide range of disorders may manifest with chest discomfort and may include both cardiovascular and noncardiovascular etiologies (Table 4-3). A careful history focused on cardiac risk factors, physical examination, and initial laboratory evaluation usually narrows the differ...

Differential Diagnosis A wide range of disorders may manifest with chest discomfort and may include both cardiovascular and noncardiovascular etiologies (Table 4-3). A careful history focused on cardiac risk factors, physical examination, and initial laboratory evaluation usually narrows the differential diagnosis. In patients with established IHD, always look for exacerbating factors that contribute to ischemia. Any process that reduces myocardial oxygen supply or increases demand can cause or exacerbate angina (Table 4-4). TABLE 4-3 Differential Diagnosis of Chest Pain Excluding Epicardial Atherosclerosis Diagnosis Cardiovascular Aortic stenosis HCM Prinzmetal angina Pericarditis Comments Anginal episodes can occur with severe aortic stenosis. Subendocardial ischemia may occur with exercise and/or exertion. Coronary vasospasm that may be elicited by exertion or emotional stress. Pleuritic chest pain associated with pericardial inflammation from infectious or autoimmune disease. Aortic dissection May mimic anginal pain and/or involve the coronary arteries. Cocaine use Results in coronary vasospasm and/or thrombus formation. Other Anemia Marked anemia can result in a myocardial O2 supply–demand mismatch. Thyrotoxicosis Increase in myocardial demand may result in an O2 supply–demand mismatch. Esophageal GERD and esophageal spasm can mimic angina (responsive to NTG). disease Biliary colic Gallstones can usually be visualized on abdominal sonography. Respiratory Pneumonia with pleuritic pain, pulmonary embolism, pulmonary hypertension. diseases Musculoskeletal Costochondritis, cervical radiculopathy. GERD, gastroesophageal reflux disease; HCM, hypertrophic cardiomyopathy; NTG, nitroglycerin. TABLE 4-4 Conditions That May Provoke or Exacerbate Ischemia/Angina Independent of Worsening Atherosclerosis Increased Oxygen Demand Noncardiac Decreased Oxygen Supply Hyperthermia Hyperthyroidism Sympathomimetic toxicity cocaine use) Hypertension Anxiety (i.e., Anemia Sickle cell disease Hypoxemia Pneumonia Asthma exacerbation Chronic obstructive pulmonary disease Pulmonary hypertension Pulmonary fibrosis Obstructive sleep apnea Pulmonary embolus Sympathomimetic toxicity (i.e., cocaine use, pheochromocytoma) Hyperviscosity Polycythemia Leukemia Thrombocytosis Hypergammaglobulinemia Cardiac Hypertrophic cardiomyopathy Aortic stenosis Dilated cardiomyopathy Tachycardia Ventricular Supraventricular Aortic stenosis Elevated left ventricular end-diastolic pressure Hypertrophic cardiomyopathy Microvascular disease Data from AHA/ACC Guidelines on Stable Ischemic Heart Disease; Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60(24):e44-e164; Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64(18):1929-1949. Freemedicalbooks4download