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Chest Pain - Diagnosis and Workup Algorithm

History and Exam
Acute life-threatening causes:
 • Acute myocardial infarction
 •
Chest Pain - Diagnosis ... Pneumothorax • Pulmonary ... embolism • Cardiac ... ultrasound • CXR ... Serial troponin; HEART
Tetralogy of Falot on Chest X-Ray
Tetralogy of Falot comprises four defects -
1. Ventricular septal defect (VSD)
2.
typical boot shaped heart ... caused the upturned cardiac ... along with concave Pulmonary ... the most common cardiac ... #XRay #CXR #clinical
Transposition of Great Arteries (TGA) on Chest XRay
 - Oval Shaped Cardiac Silhouette 
 - Narrow
Arteries (TGA) on Chest ... - Oval Shaped Cardiac ... - Increased pulmonary ... GreatArteries #TGA #CXR ... #Clinical
Hypoxemia Differential Diagnosis Algorithm by A-a Gradient

Normal A-a Gradient:
 • ↓ Atmospheric pressure
 • Hypoventilation: CNS
Algorithm by A-a ... Hypoventilation: CNS ... neuromuscular disease, ↓ chest ... Right-to-Left Shunt: Cardiac ... #Algorithm #pulmonary
Congenital absence of the pericardium: 
- CXR: leftward shift of the cardiac silhouette, Snoopy sign, no
leftward shift of the cardiac ... displacement of the heart ... #pericardium #CardiacMRI ... CMRI #cardiology #chest ... #radiology #clinical
Sarcoidosis 
Non-caseating granulomas (Composed of T-helper & inflammatory cells) 
Clinical:
 • Disease fatal in 10% of
inflammatory cells) Clinical ... fatal in 10% of pts ... lupus pernio • Cardiac ... : Heart failure, ... #Sarcoidosis #Diagnosis
Heart failure with Reduced Ejection Fraction (HFrEF)
Clinical Presentation
1. Typical symptoms: dyspnea, orthopnea paroxysmal noctumal dyspnea, fatigue,
Fraction (HFrEF) Clinical ... Chest x-ray: signs ... effusions). 1/5 pts ... → no signs of CXR ... Consider cardiac
Atrial Fibrillation (A-Fib) Summary

Symptoms:
• Palpitations, light-headedness, dizziness, dyspnea, exercise intolerance, chest pain, near-syncope, syncope.

Why?
Cardiac:
	• Valvular heart
exercise intolerance, chest ... Cardiac: • Valvular ... Noncardiac: • Pulmonary ... early Afib and pts ... Fibrillation #AFib #diagnosis
Basics of Waveform Capnography
Waveform capnography assesses ventilation by monitoring exhaled carbon dioxide
Can use measurement and morphology
pathophysiology CLINICAL ... • Monitoring cardiac ... transmitted from the heart ... - Shock/low cardiac ... interpretation #patterns #diagnosis
Preoperative Risk Evaluation

Major Pre-Op Questions:
1. Does the patient have any modifiable risk factors that could be
exam Determine Cardiac ... event, follow ACC algorithm ... Change in clinical ... change CV risk Chest ... postoperative cardiac