Differential Diagnosis Of Chest Pain Research Articles

The Unusual Presentation of Acute Pericarditis Mimicking Acute Coronary Syndrome

Pericarditis is a common disorder that might present in various settings, including primary-care and emergency department. However, the clinical features in some cases did not match with the written theory, which could lead to a misdiagnosis. A 46-year-old man presented to the emergency room with progressive tightness chest pain, epigastric pain, nausea, and vomiting in the past 2 days. Based on the clinical, electrocardiograph (ECG), and laboratory evaluation, the patient was diagnosed with unstable angina pectoris and treated accordingly but did not showed an improvement. Clinical re-examination and echocardiography evaluation showed a pathognomonic finding of pericarditis feature. Combination therapy of colchicine and ibuprofen was given for 3 weeks. One-month follow-up evaluation showed normal ECG and echocardiography result without any remaining symptoms. Acute pericarditis does not always show typical finding. Therefore, clinician must always aware with other differential diagnosis of chest pain and ECG variation of acute pericarditis.

Hematoma mediastinal tímico, complicación infrecuente del cateterismo cardiaco por abordaje radial

Las complicaciones vasculares en los cateterismos cardiacos en general son infrecuentes y están en relación directa con el sitio específico de la punción vascular. Dado que el hematoma tímico es de rara ocurrencia, no suele considerase entre los diagnósticos diferenciales del dolor torácico poscateterismo cardiaco. Se presenta el caso de una paciente de 62 años que desarrolló un hematoma tímico luego de practicar una arteriografía coronaria.

A Case of Spontaneous Pneumomediastinum

Introduction:
 Spontaneous pneumomediastinum is described as the
 presence of air in the mediastinum without any specific etiological factor or
 trauma, and it is a rare clinical situation. In this case report, a rare
 case of spontaneous pneumomediastinum was presented. Case
 report: A
 23-year-old male patient was admitted to our emergency department with the
 complaints of throat congestion, difficulty in breathing and chest pain while playing soccer. An increase of
 linear-type transparency starting from the right paratracheal area and
 extending to the mediastinum, and a subcutaneous emphysema in the neck region
 were detected on the posteroanterior (PA) chest X-ray of the patient, which is
 compatible with pneumomediastinum (PM).  
 
 
 
 
 
 
 
 Conclusion:
 History, systemic examination and radiological imaging are very important for
 the patients with chest pain. Spontaneous pneumomediastinum should be taken into consideration in
 the differential diagnosis of chest pain and breathing distress.

Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease.

To analyse extracardiac findings in patients without significant coronary artery disease (CAD) in general and in symptomatic patients in particular. We searched the Radiology Information System database for coronary computed tomography angiographies (CTA) performed from 2000-2014 and retrospectively enrolled 3,898 patients without significant CAD (coronary stenosis < 50%) in CTA. In 2,330 symptomatic patients, we analysed the spectrum of extracardiac findings and identified pathologies potentially explaining chest pain. Finally, we investigated variables affecting the number of extracardiac findings detected in CTA. Overall extracardiac findings were found in 1,177 patients (30.2%; 95%CI, 28.8-31.7%). 94 patients (2.4%; 95%CI, 2.0-2.9%) had extracardiac findings with a recommendation for follow-up, sixteen patients (0.4%; 95%CI, 0.3-0.7%) had incidental urgent, and another three patients (0.1%; 95%CI, 0.1-0.2%) had incidental malignant extracardiac findings. 185 of 2,330 symptomatic patients (7.9%; 95%CI, 6.9-9.1%) revealed extracardiac findings potentially explaining chest pain after exclusion of significant CAD. The number of extracardiac findings increased significantly with patient age (p < 0.001) and the cumulative experience of the CT reader (p < 0.001). 30.2% of patients undergoing CTA for exclusion of CAD had ECF, and 7.9% of symptomatic patients without significant CAD on their examination had findings that could potentially explain their symptoms. • Of patients undergoing CTA, 2.8% have relevant incidental extracardiac findings. • CTA could identify the differential diagnosis of chest pain when excluding significant CAD. • Patient age and reader's professional experience influence the number of detected ECFs.

Sudden Death Due to Thoracic Aortic Dissection in Young People: A Multicenter Forensic Study.

Thoracic aortic dissection (TAD) is infrequent in young people and its characteristics differ from those in the adult population. This study aimed to analyze the clinical and pathological characteristics of sudden death due to TAD in people aged 1 to 35 years. Multicenter population-based study based on forensic autopsies conducted in the provinces of Biscay (1991-2016), Valencia (2000-2016), and Seville (2004-2016). We identified 35 individuals with sudden death due to TAD (80% males), with a mean age of 29±5 years. The incidence was 0.09/100 000 inhabitants/y. Eighteen persons had at least 1 risk factor for TAD, and this figure increased to 29 when postmortem findings were included: congenital heart disease (n=16), suspicion of familial TAD (n=11), cocaine use (n=6), and hypertension (n=5). Twenty-four individuals, 12 with at least 1 risk factor, had prodromal symptoms, and 16 of them visited their physician, but TAD was not suspected in any of them. The most frequent symptom was chest pain (n=12). The main autopsy findings were cystic degeneration of the media (n=27), dilatation of the ascending aorta (n=21), cardiac hypertrophy (n=20), and bicuspid aortic valve (n=14). The incidence of sudden death due to TAD in young people was very low. The most frequent risk factors were congenital heart disease followed by suspicion of familial TAD and cocaine use. TAD should be included in the differential diagnosis of chest pain in young people, mainly male patients with at least 1 risk factor.

Distress in My Chest: The Approach to a Student Presenting With "Chest Pain".

Occasionally, students present with chest pain in the school setting. Therefore, it is important to develop a differential diagnosis for chest pain, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of a student presenting with chest pain.

Muerte súbita por disección de aorta torácica en jóvenes: estudio multicéntrico forense

Introduction and objectivesThoracic aortic dissection (TAD) is infrequent in young people and its characteristics differ from those in the adult population. This study aimed to analyze the clinical and pathological characteristics of sudden death due to TAD in people aged 1 to 35 years. MethodsMulticenter population-based study based on forensic autopsies conducted in the provinces of Biscay (1991-2016), Valencia (2000-2016), and Seville (2004-2016). ResultsWe identified 35 individuals with sudden death due to TAD (80% males), with a mean age of 29±5 years. The incidence was 0.09/100 000 inhabitants/y. Eighteen persons had at least 1 risk factor for TAD, and this figure increased to 29 when postmortem findings were included: congenital heart disease (n=16), suspicion of familial TAD (n=11), cocaine use (n=6), and hypertension (n=5). Twenty-four individuals, 12 with at least 1 risk factor, had prodromal symptoms, and 16 of them visited their physician, but TAD was not suspected in any of them. The most frequent symptom was chest pain (n=12). The main autopsy findings were cystic degeneration of the media (n=27), dilatation of the ascending aorta (n=21), cardiac hypertrophy (n=20), and bicuspid aortic valve (n=14). ConclusionsThe incidence of sudden death due to TAD in young people was very low. The most frequent risk factors were congenital heart disease followed by suspicion of familial TAD and cocaine use. TAD should be included in the differential diagnosis of chest pain in young people, mainly male patients with at least 1 risk factor.

Dolor torácico no coronario. Papel del electrocardiograma en el diagnóstico diferencial de la pericarditis aguda y la repolarización precoz

Introduction and objectivesElectrocardiogram plays a fundamental role in the differential diagnosis of chest pain. It is sometimes difficult to differentiate these 2 entities: acute pericarditis and early repolarization. The aim of this study was to establish electrocardiographic characteristic to allow their differentiation. MethodWe included retrospectively a sample of patients who were hospitalized due to a non ischemic chest pain who showed ST segment elevation on the electrocardiogram between January 2010-December 2015. The patients were classified according to the electrocardiographic evolution and presence/absence of other pericarditis criteria in 2 groups: acute pericarditis and chest pain with a pattern of early repolarization. ResultsThe study included 93 patients (76 patients with acute pericarditis and 17 patients with early repolarization) and they had a mean age of 35±15 years, whom 80% were male. The patients with acute pericarditis showed higher ST segment elevation and a bigger ST/T ratio in V5 and V6, being the result statistically significant (P<.001). ST/T ratio in V5 with a cut-off point of 0.19 appears to be the most discriminative parameter in a significant way. ConclusionsST segment elevation and fundamentally ST/T ratio in V5 and V6 are useful for the differential diagnostic between acute pericarditis and early repolarization.

ÇOCUK HASTADA NADİR BİR GÖĞÜS AĞRISI NEDENİ: SPONTAN PNÖMOMEDİASTİNUM

Spontaneous pneumomediastinum (Hamman's syndrome) is a rare, self-limiting disorder commonly seen in young adult males. It occurs by the flow of air towards to the hilum and mediastinum due to increaced intrathoracic pressure secondary to alveolar rupture. The cases usually present with the complaints of chest pain, neck pain, back pain, dysphonia, dysphagia and coughing. In this article, we present a case of spontaneous pneumomediastinum (SPM), who admitted to the pediatric emergency clinic with the complaint of chest pain. SPM should be kept in mind in the differential diagnosis of chest pain.

Mondor\u2019s disease \u2013 a rare cause of chest pain: a case report

BackgroundChest pain is one of the common presenting symptoms encountered in an emergency department. Prompt history taking and careful clinical examination do help to differentiate cardiac chest pain from other causes. Mondor’s disease is a rare cause of chest pain which is often underdiagnosed due to lack of awareness. Mondor’s disease is a condition characterized by thrombophlebitis of the superficial veins of breast and anterior chest wall. The diagnosis is often made clinically.Case presentationHere we report a case of a 37-year-old Sri Lankan Tamil woman who presented with chest pain and was clinically diagnosed as having Mondor’s disease after a physical examination, which was confirmed with demonstration of thrombophlebitis by ultrasound scan imaging. Although it is a self-limiting condition, non-steroidal anti-inflammatory drugs are used in the treatment to hasten recovery in addition to giving reassurance.ConclusionsMondor’s disease is not considered a differential diagnosis for chest pain due to lack of awareness of this medical condition. Creating awareness of this condition via this case would help to cut down unnecessary investigations and valuable time spent in emergency departments, and it helps to identify a serious underlying cause especially carcinoma of the breast at its early stage.

Telecardiology on the Diagnostic Support of Chest Pain in Twenty-Two Emergency Care Units (UPA 24h) in The State of Rio de Janeiro

Abstract Background: Telecardiology may be a useful support in diagnosis and management of chest pain. Objective: Evaluate the application of telecardiology to support the differential diagnosis of chest pain in patients admitted to Emergency Care Units. Method: Observational, retrospective and documental study of 5,816 patients admitted with supposedly cardiological chest pain in twenty two Emergency Care Units in the state of Rio de Janeiro. Data were tabulated and analyzed by Excel® software, using simple descriptive statistics, from the database of the Cardiology Consultancy Nucleus. Results: Diagnostic disagreement was found in 1,593 (27.39%) cases. Of these, 1,477 (92.72%) were diagnosed locally as non-ST-elevation myocardial infarction (non-STEMI), 74 (4.64%) as acute myocardial infarction with ST-segment elevation (STEMI), 40 (2.52%) as acute pulmonary edema (APE) and 2 (0.12%) as tachyarrhythmia. Intensive care referral was requested to 100% of these patients. After telecardiology, the diagnoses were: 385 (24.17%) unstable angina, 289 (18.14%) congestive heart failure, 212 (13.31%) APE, 174 (10.92%) STEMI, 152 (9.54%) hypertensive emergency, 113 (7.09%) acute chronic renal failure, 89 (5.59%) non-STEMI, 89 (5.59%) pneumonia, 39 (2.45%) sepsis, 26 (1.63 %) myopericarditis, 20 (1.26%) tachyarrhythmia and 5 (0.31%) orovalvar disease. The outcome after telecardiology was 1,178 discharges (73.94%), 338 (21.21%) referrals, 62 (3.90%) deaths and 15 (0.95%) unknown. Conclusion: Telecardiology was effective in chest pain diagnosis and management, optimizing hospital admission in the public health system.

ОСТРЫЙ ПЕРИКАРДИТ В РАМКАХ ДИФФЕРЕНЦИАЛЬНОГО ДИАГНОЗА БОЛЕЙ В ГРУДНОЙ КЛЕТКЕ

ОСТРЫЙ ПЕРИКАРДИТ В РАМКАХ ДИФФЕРЕНЦИАЛЬНОГО ДИАГНОЗА БОЛЕЙ В ГРУДНОЙ КЛЕТКЕ

Spontaneous pneumomediastinum after bench press training.

Key Clinical MessageSpontaneous pneumomediastinum is often associated with asthma and mainly affects adolescent males with a tall, thin body habitus. A 17‐year‐old man complained of chest and pharyngeal pain after bench press training and spontaneous pneumomediastinum was diagnosed. It should be considered in the differential diagnosis of chest pain of uncertain cause.

Hemorrhagic Pericardial Cyst Diagnosis Accelerated by Emergency Physician Echocardiography: A Case Report

BackgroundThe differential diagnosis for chest pain in the emergency department is broad and includes both benign and life-threatening conditions–with pericardial cyst as a rare example. Emergency physician-performed point-of-care focused cardiac ultrasound (FOCUS) is increasingly recognized as a useful modality in the evaluation of patients with chest pain. Case ReportWe report a case of hemorrhagic pericardial cyst in a young woman presenting with chest pain in which findings on FOCUS contradicted findings on chest x-ray study and thus, accelerated diagnosis and definitive treatment. We also comment on epidemiology, pathophysiology, clinical presentation, diagnosis, and management of this uncommon, potentially fatal cause of chest pain. Why Should an Emergency Physician Be Aware of This?This case report aims to bring an uncommon case to the attention of emergency providers and emphasize the importance of facility with FOCUS. Although definitive diagnosis and management were not accomplished at the bedside in this case, an abnormal finding on FOCUS prompted further investigation and timely treatment.

Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years.

ABSTRACTObjective:To characterize clinically all of the patients with spontaneous pneumomediastinum (SPM) admitted to an adult pulmonology ward in Lisbon, Portugal. Methods:This was a retrospective descriptive study of all adult patients (≥ 18 years of age) diagnosed with SPM between January of 2004 and September of 2015. Results:At least one predisposing factor was identified in most (88.9%) of the 18 patients who presented with SPM during the study period. With regard to precipitating factors, bouts of cough were present in 50.0% of the patients. Other precipitating factors included a sudden increase in tobacco consumption, inhaled drug use, occupational inhalation of varnish fumes, intense exercise, and vomiting. The most common complaints were dyspnea (in 83.3%) and chest pain (in 77.8%). Other complaints included cough, neck pain, dysphagia, and odynophagia. Subcutaneous emphysema was found in most of the patients. The diagnosis of SPM was based on chest X-ray findings in 61.1% of the patients. Conclusions:Although SPM is a rare condition, it should be considered in the differential diagnosis of chest pain and dyspnea. It can develop without a triggering event or conclusive findings on a chest X-ray, which is usually sufficient for diagnosis.

A Rare Cause of Chest Pain Mimicking Coronary Artery Disease

Chest pain accounts for 6% of emergency room presentations (1). Differential diagnosis of chest pain ranges from benign pain arising from musculoskeletal system to the malignant reasons that may be fatal unless diagnosed and treated promptly such as myocardial infarction and aortic dissection. It is difficult to exclude cardiovascular causes of chest pain in the patients with atherosclerotic risk factors even chest pain is atypical, and coronary angiography may become obligatory to exclude myocardial ischemia. Herein, we present seven patients, who presented to the cardiology clinic of our hospital with chest pain, in whom coronary angiography has become obligatory for the exclusion of myocardial ischemia, and of whom further examinations after exclusion of myocardial ischemia revealed thoracic schwannoma.

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation-liaison (C-L) psychiatrists and other mental health providers. We reviewed prior published work on (1) the appropriate medical workup of the acute presentation of chest pain, (2) the relevant medical and psychiatric differential diagnosis for chest pain determined to be non-cardiac in origin, (3) the management of related conditions in psychosomatic medicine, and (4) management strategies for patients with NCCP. We identified key differential diagnostic and therapeutic considerations for psychosomatic medicine providers in 3 different clinical contexts: acute care in the emergency department, inpatient C-L psychiatry, and outpatient C-L psychiatry. We also identified several gaps in the literature surrounding the short-term and long-term management of NCCP in patients with psychiatric etiologies or co-morbid psychiatric conditions. Though some approaches to the care of patients with NCCP have been developed, more work is needed to determine the most effective management techniques for this unique and high-morbidity population.

The Unknown Association of PPIs With Chest Pain in Patients With Known, Treated Coronary Artery Disease—A Diagnostic Dilemma

Patients with coronary artery disease (CAD) are destined to lifelong antiplatelet therapy in form of aspirin (acetylsalicylic acid) alone, or in combination with other P2Y2 inhibitors. Proton pump inhibitors (PPIs) are the preferred agents for the treatment and prophylaxis of gastrointestinal injury associated with nonsteroidal anti-inflammatory drug or acetylsalicylic acid or both,1 but recent data has raised questions about their association with negative cardiovascular events. We report 2 cases of patients with known CAD presented with chest pain mimicking angina pectoris that successfully resolved on discontinuation of the PPIs. One male and one female patient with known history of CAD receiving PPIs were referred to us with symptoms of refractory angina that was unresponsive to conventional optimized medical therapy. The angina was reported to be related to exertion in both the patients. Neither patient had a diagnosis of Prinzmetal angina or peptic ulcer disease; however, both patients reported a history of gastroesophageal reflux disease. Both patients were on dual antiplatelet therapy. No ischemic changes on the electrocardiogram were noted for either patient. Patient 1 had an exercise stress test that was negative for any inducible ischemia whereas patient 2 had no obstructive lesion seen on coronary angiography. Both patients reported to be symptom free after discontinuation of PPIs at 8 months of follow-up. It is our opinion that a relationship between PPIs and angina-like chest pain is plausible, as these 2 cases demonstrate the causative role of PPIs in precipitation of their symptoms. We postulate that this association should be considered in differential diagnosis of chest pain. In light of above findings we suggest that this is hypothesis generating and we are exploring the role of PPIs in patients with history of CAD and refractory angina-like symptoms despite complete revascularization.

Chest Pain may be the First Symptom of Malignant Tumors in Children: Report of Two Cases

The majority of chest pain in children is idiopathic or associated with locomotor system pathologies. Albeit cardiac and other thoracic malign tumors may cause chest pain, malignancies usually show rapid clinical onset and are presented with multiple systemic symptoms. It is not a usual finding for chest pain being the sole initial symptom. Herein, we report two children who were presented with chest pain as an initial symptom and diagnosed with fibrosarcoma and lymphoma afterwards. Therefore, we want to emphasize that cardiac and pericardial malignant tumors should be remembered in differential diagnosis of chest pain in children. Key words: Chest pain, fibrosarcoma, lymphoma, children

Elevated troponin levels and typical chest pain: Is always acute coronary syndrome?

<br>Aortic dissection is a fatal disease that must be considered in the differential diagnosis of chest pain. If the diagnosis cannot be made in early period, mortality is very high. Here, we present a case of aortic dissection, clinically mimicking acute coronary syndrome.