Typical Presentation | DDx | Workup |
Retrosternal burning sensation After heavy meals and when lying down Sx relieved by antacids | GERD
Esophagitis Peptic ulcer Esophageal spasm | ECG Barium swallow Upper endoscopy |
Retrosternal squeezing pain Lasts for 2 min Occurs w/ exercise Relieved by rest and not related to food intake | Angina
Esophageal spasm Esophagitis | ECG CXR CK-MB, troponin CBC, electrolytes Exercise stress test Upper endoscopy |
Retrosternal stabbing pain Improves when leaning forward Worsens w/ deep inspiration Had URI 1 wk ago | Pericarditis
Aortic dissection MI Costochondritis GERD Esophagreal rupture | ECG CXR, Chest CT CK-MB, troponin Echocardiography CBC Upper endoscopy |
Stabbing pain Worsens w/ deep inspiration Relieved by aspirin Had URI 1 wk ago + chest wall tenderness | Costochondritis
Pneumonia MI PE Pericarditis Muscle strain | ECG CXR CK-MB, tropnin CBC |
Acute onset of SOB at rest Pleuritis CP tachycardia, hypotension, tachypnea, mild fever Long-term immobilization | PE
Pneumonia Costochondritis MI CHF Aortic dissection | ECG CXR ABG |
Sudden onset of severe CP Radiates to the back Hx of uncontrolled HTN | Aortic dissection
MI Pericarditis Esophageal rupture Pancreatitis | ECG CKEMB, troponin CXR, MRI CBC, amylase, lipase TEE (transesophagreal echocardiography) |
Sudden onset Substernal heavy CP Radiates to L arm dyspnea, diaphoresis, nausea | MI
ERD Angina Costochondritis Aortic dissection Pericarditis PE | ECG CXR CK-MB, troponin CBC, electrolytes Echocardiography Cardiac catheterization |