1. Chest pain Seminar Prepared by | Abdullah A. Laftal Group 32 | Medicine 3

2. Objectives :  define chest pain.  state the causes, prevalence  management of patient with chest pain

3. Chest pain :  symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain

4. Case 1 :  A 53-year-old man was admitted to the hospital.  The patient had been well until three months earlier, when he began to have increasingly severe exertional dyspnea, without chest pain.

5.  On the day of admission, he had been at work, lifting and transporting heavy objects, when a sensation of "heaviness" developed across his chest, accompanied by dyspnea.  In an ambulance en route to this hospital, ventricular fibrillation was discovered, and a single shock resulted in reversion to a normal rhythm.

6.  An electrocardiogram obtained at the time of his arrival at this hospital showed elevated ST segments in leads V 1 through V 4, with depressed ST segments in leads II and III  The patient had a 40-pack-year history of cigarette smoking; he drank little alcohol. He had hypertension and hyperlipidemia and took medications for both. There was no history of diabetes mellitus or previous chest pain and no family history of coronary disease.

7.  On physical examination : Temperature was 38.3°C pulse was 85 blood pressure was 115/80 mm Hg. The patient was alert and comfortable. The jugular venous pressure was 8 cm of water. Bibasal crackles were present. A grade 1 systolic murmur was heard, with a third heart sound. The abdomen was normal and there was no peripheral edema.

8. Management : Oxygen, lidocaine, aspirin, and metoprolol were administered, the patient was transported urgently to the cardiac catheterization unit. A coronary angiographic study revealed three-vessel disease, including complete occlusion of the left anterior descending artery at its ostium. A stent was placed

9. DDx : Pulmonary pneumonia pulmonary embolism (PE)* pneumothorax/hemothorax* empyema pulmonary neoplasm bronchiectasis TB

10. Cardiac MI angina* myocarditis Pericarditis cardiac tamponade*

11. Gastrointestinal Esophageal spasm, GERD, esophagitis, ulceration, achalasia, neoplasm PUD gastritis pancreatitis biliary colic

12. mediastinal lymphoma Thymoma vascular aortic aneurysm surface structures costochondritis rib fracture skin (bruising, shingles) breast

13. Chest pain :

17. Disorder Mediastinal displacement Chest wall movement Percussion noteBreath soundsAdded sounds ConsolidationNoneReduced over affected area DullBronchialCrackles TBNone Pleural effusionHeart displaced to opposite side (trachea displaced only if massive) Reduced over affected area Stony dullAbsent over fluid; may be bronchial at upper border Absent; pleural rub may be found above effusion PneumothoraxTracheal deviation to opposite side if under tension Decreased over affected area ResonantAbsent or greatly reduced Absent PENone Pleural friction rub

18. An infiltrate in the medial segment of the right middle lobe will obscure the right heart border on the frontal view, on the lateral view, is seen as a triangular density radiating from the hilum toward the anterior and lower part of the chest

28. Group 32 medical student send the gratitude and thanks to Dr.Abdullah Assiri Dr.Mohammad Younis Khan for their support. Also to the organizing committee of SHA 21 scientific session for encourage young researchers