Objectives
- Describe pathogenesis of IHD & essential elements of history taking & the physical examination for a patient with chest pain.
- Develop a broad differential diagnosis of chest pain, including cardiac & non-cardiac causes.
- Describe appropriate diagnostic testing for patient presenting with chest pain.
Additional Objectives
- Describe use of laboratory studies in the evaluation of patient with chest pain (e.g. CK-MB, Troponins, etc.).
- Interpret an ECG of a patient presenting with chest pain & suspicious of acute MI, and its location as anterior, lateral, and posterior.
- Describe current guidelines for the initial management of a patient presenting with chest pain.
- Discuss modifiable & non-modifiable risk factors for cardiac disease.
- Utilize point of care resources to determine the risk of cardiac disease for an individual patient as defined by the Framingham Heart Study data.
- Demonstrate therapeutic communication while working with patients and families during a time of crisis.
Key Points
- Not every chest pain is MI, however every chest pain should be considered as ischemic until proven otherwise
- A good history and physical exam may help with the diagnosis
- EKG is the best single diagnostic test to help rule out MI
- Use the TIMI scoring system to help for the diagnosis and prognosis of MI
Summary
- Chest pain is a very common complaint but has a broad differential.
- Always try to rule out the life-threatening causes of chest pain.
- It is important to remember that troponin elevation DOES NOT always mean ACS.
- Use the history, physical exam, labs, EKG, and imaging to commit to a diagnosis.
- Whenever you are stuck, ask for help. Your seniors are here to help you!