Myocardial Infarction (MI) |
- Severe, crushing chest pain, often radiating to the left arm, jaw, or back
- Associated with sweating, nausea, shortness of breath, and dizziness
- Pain lasts longer than 20 minutes and is not relieved by rest
- History of coronary artery disease, hypertension, diabetes, or smoking
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- Electrocardiogram (ECG): ST-segment elevation, T-wave inversion, or new left bundle branch block
- Cardiac Biomarkers: Elevated troponin and CK-MB
- Chest X-ray: To rule out other causes of chest pain
- Coronary Angiography: To identify and treat the occluded coronary artery
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- Immediate Reperfusion: PCI (Percutaneous Coronary Intervention) or thrombolytic therapy
- Antiplatelet Therapy: Aspirin, clopidogrel
- Anticoagulation: Heparin or low-molecular-weight heparin
- Beta-blockers and ACE Inhibitors: To reduce myocardial oxygen demand and improve survival
- Long-term Management: Lifestyle changes, cardiac rehabilitation, and secondary prevention with medications
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Angina Pectoris |
- Chest pain or discomfort, often described as pressure or squeezing
- Pain typically occurs with exertion or stress and is relieved by rest or nitroglycerin
- May radiate to the neck, jaw, shoulders, or arms
- Associated with shortness of breath and fatigue
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- Electrocardiogram (ECG): May show ST-segment depression during an episode
- Stress Testing: To provoke symptoms and evaluate for ischaemia
- Echocardiography: To assess heart function and detect wall motion abnormalities
- Coronary Angiography: To visualize coronary artery stenosis
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- Nitroglycerin: Sublingual tablets or spray for acute episodes
- Beta-blockers: To reduce heart rate and myocardial oxygen demand
- Calcium Channel Blockers: For patients intolerant to beta-blockers or with vasospastic angina
- Aspirin: To reduce the risk of thrombosis
- Lifestyle Modifications: Smoking cessation, diet, exercise
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Pulmonary Embolism (PE) |
- Sudden onset of pleuritic chest pain (sharp, worse with inspiration)
- Associated with dyspnoea, tachypnea, tachycardia, and hypoxia
- History of deep vein thrombosis (DVT), recent surgery, prolonged immobility, or malignancy
- Possible haemoptysis and signs of right heart strain
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- D-dimer: Elevated levels suggest a thrombotic process
- CT Pulmonary Angiography (CTPA): Gold standard for diagnosing PE
- Ventilation-Perfusion (V/Q) Scan: Alternative imaging, especially for patients who cannot undergo CTPA
- ECG: May show signs of right heart strain (e.g., S1Q3T3 pattern)
- Chest X-ray: Often normal but may show atelectasis or pleural effusion
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- Anticoagulation: Heparin, low-molecular-weight heparin, or direct oral anticoagulants (DOACs)
- Thrombolytic Therapy: Considered in massive PE with haemodynamic instability
- Supportive Care: Oxygen therapy, IV fluids for hypotension
- Inferior Vena Cava (IVC) Filter: For patients with contraindications to anticoagulation
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Pneumothorax |
- Sudden onset of unilateral pleuritic chest pain and shortness of breath
- Decreased or absent breath sounds on the affected side
- Hyperresonance to percussion on the affected side
- Tachypnea and tachycardia
- In tension pneumothorax: hypotension, tracheal deviation, and jugular venous distension
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- Chest X-ray: To confirm the presence of air in the pleural space
- CT Scan: May be used if the diagnosis is unclear or in trauma cases
- Arterial Blood Gas (ABG): To assess for hypoxia and respiratory acidosis
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- Needle Decompression: For tension pneumothorax followed by chest tube insertion
- Chest Tube Insertion: To re-expand the lung in significant or symptomatic pneumothorax
- Observation: For small, stable pneumothorax in healthy individuals
- Surgical Intervention: Thoracoscopy or pleurodesis for recurrent or large pneumothoraces
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Gastro-oesophageal Reflux Disease (GORD) |
- Burning chest pain (heartburn) that may radiate to the throat
- Worsens after eating, lying down, or bending over
- Associated with regurgitation, sour taste, and chronic cough
- Relieved by antacids or acid-suppressing medications
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- Clinical Diagnosis: Based on history and symptom relief with antacids
- Endoscopy: For patients with alarm symptoms or those who do not respond to treatment
- 24-Hour pH Monitoring: To confirm acid reflux and correlate with symptoms
- Esophageal Manometry: To assess for oesophageal motility disorders
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- Lifestyle Modifications: Weight loss, dietary changes, elevating the head of the bed
- Antacids: For quick relief of symptoms
- Proton Pump Inhibitors (PPIs): First-line treatment for acid suppression
- H2 Receptor Antagonists: Alternative to PPIs for mild cases
- Surgical Options: Fundoplication for refractory GERD
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Musculoskeletal Causes (e.g., Costochondritis) |
- Sharp, localized chest pain, often reproducible with palpation
- Pain may be exacerbated by movement, deep breathing, or coughing
- No associated cardiovascular or pulmonary symptoms
- History of recent physical activity or trauma to the chest wall
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- Clinical Diagnosis: Based on history and physical examination
- Chest X-ray: Typically normal, used to rule out other causes of chest pain
- MRI or Ultrasound: Rarely needed, but may be used to assess for soft tissue abnormalities
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- NSAIDs: For pain relief and inflammation reduction
- Rest and Activity Modification: Avoiding activities that exacerbate pain
- Local Heat or Ice: To alleviate symptoms
- Physical Therapy: To improve posture and strengthen chest muscles if necessary
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Pneumonia |
- Pleuritic chest pain, productive cough, fever, and dyspnoea
- Crackles or bronchial breath sounds on auscultation
- Possible history of recent upper respiratory tract infection
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- Chest X-ray: To identify infiltrates or consolidation
- Blood Cultures: To identify causative organisms in severe cases
- Sputum Culture: To guide antibiotic therapy
- Full Blood Count (FBC): To assess for leukocytosis
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- Antibiotic Therapy: Based on likely pathogens and severity (e.g., macrolides, beta-lactams)
- Supportive Care: Oxygen therapy, fluids, antipyretics
- Hospitalization: For severe cases or patients with comorbidities
- Vaccination: Pneumococcal and influenza vaccines to prevent future episodes
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Aortic Dissection |
- Severe, tearing chest pain that radiates to the back
- Sudden onset, often associated with hypotension and signs of shock
- Asymmetry in blood pressure between arms
- History of hypertension or connective tissue disorders (e.g., Marfan syndrome)
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- CT Angiography: Gold standard for diagnosis, showing the intimal flap
- Transesophageal Echocardiography (TEE): Useful in unstable patients
- Chest X-ray: May show a widened mediastinum
- ECG: Typically normal or nonspecific changes
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- Emergency Surgery: For type A dissections (ascending aorta)
- Blood Pressure Control: IV beta-blockers (e.g., esmolol) to reduce shear stress on the aorta
- Pain Management: Opiates for pain control
- Long-term Management: Strict blood pressure control and surveillance imaging
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Pleuritis/Pleurisy |
- Sharp, stabbing chest pain that worsens with deep breathing or coughing
- Pleural friction rub on auscultation
- May be associated with viral infections or autoimmune diseases (e.g., lupus)
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- Chest X-ray: To rule out other causes of pleuritic chest pain
- Ultrasound: May detect pleural effusion
- Blood Tests: To assess for infection or autoimmune markers
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- NSAIDs: For pain and inflammation relief
- Treatment of Underlying Cause: Antibiotics for bacterial infections, corticosteroids for autoimmune conditions
- Supportive Care: Rest and hydration
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Panic Disorder |
- Chest pain often accompanied by palpitations, shortness of breath, dizziness, and a sense of impending doom
- Pain is not related to exertion and may be accompanied by hyperventilation
- Symptoms typically peak within minutes and resolve spontaneously
- History of anxiety or panic attacks
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- Clinical Diagnosis: Based on history and exclusion of other causes of chest pain
- ECG and Cardiac Enzymes: To rule out myocardial ischaemia
- Psychological Assessment: To evaluate for anxiety and panic disorders
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- Cognitive Behavioral Therapy (CBT): To address anxiety and panic symptoms
- Anxiolytics: Benzodiazepines for acute episodes; SSRIs for long-term management
- Relaxation Techniques: Breathing exercises and mindfulness
- Lifestyle Modifications: Regular exercise, sleep hygiene, and avoiding caffeine
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Pericarditis |
- Sharp, pleuritic chest pain that is relieved by sitting up and leaning forward
- Pericardial friction rub on auscultation
- Pain may radiate to the trapezius ridge
- May be associated with viral infection, post-MI (Dressler syndrome), or autoimmune conditions
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- ECG: Diffuse ST-segment elevation and PR-segment depression
- Echocardiography: To assess for pericardial effusion
- Chest X-ray: May show an enlarged cardiac silhouette if significant effusion is present
- Blood Tests: Elevated inflammatory markers (e.g., ESR, CRP)
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- NSAIDs or Aspirin: First-line treatment for pain and inflammation
- Colchicine: To reduce recurrence
- Corticosteroids: For refractory cases or autoimmune-related pericarditis
- Pericardiocentesis: For large effusions or tamponade
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