Determining the Cause

Chief Complain: Chest Pain

Unstable Patient

Pivotal Assessments (one after the other) Finding

EKG

 

 ST Segment Elevation Non ST Segment Elevation Indeterminate Left bundle branch block Presence of Q waves T-wave inversion

Ventricular Tachycardia

Ventricular Tachycardia

 

Ventricular Fibrillation

 
              Normal
Portable Chest X-Ray Pneumothorax Pneumonia Pleural Effusion

Aortic Dissection

  1. Acute aortic dissection (AAD) - The most common type, involving a tear in the inner layer of the aortic wall
    1
    2
    .
  2. Intramural hematoma (IMH) - Bleeding within the aortic wall without an intimal tear
    1
    3
    .
  3. Penetrating atherosclerotic ulcer (PAU) - An ulceration in an atherosclerotic plaque that penetrates the internal elastic lamina
    1
    3
    .

 

  
D-Dimer* Elevated, Greater than .05 < .05

* D-Dimer Reference

Abnormal EKG findings and chest pain can arise from a wide range of causes. Here are some of the key possibilities, categorized for better understanding:

Cardiac Causes

  1. Myocardial Ischemia or Infarction (Heart Attack)

    • Reduced blood flow to the heart muscle due to blocked coronary arteries.
    • Often presents with ST-segment changes (elevation or depression), T-wave inversions, or pathological Q waves.

  2. Arrhythmias

    • Abnormal heart rhythms like atrial fibrillation, ventricular tachycardia, or premature beats.
    • May show irregular patterns, absent P waves, or wide QRS complexes.

  3. Pericarditis

    • Inflammation of the pericardium.
    • EKG may show diffuse ST-segment elevation and PR-segment depression.

  4. Hypertrophic Cardiomyopathy (HCM)

    • Thickened heart muscle, often genetic.
    • EKG findings can include left ventricular hypertrophy, deep Q waves, or T-wave inversions.

  5. Heart Failure or Left Ventricular Hypertrophy

    • Enlarged or weakened heart may show voltage criteria for hypertrophy or conduction delays.

  6. Congenital Heart Defects

    • Structural abnormalities like atrial or ventricular septal defects.

Non-Cardiac Causes

  1. Pulmonary Embolism

    • Blood clot in the lung can cause chest pain and EKG changes (e.g., S1Q3T3 pattern, right heart strain).

  2. Pneumothorax

    • Collapsed lung can mimic cardiac chest pain but is seen on imaging rather than EKG.

  3. Gastroesophageal Reflux Disease (GERD)

    • Acid reflux can cause chest discomfort mimicking angina, but EKG is usually normal.

  4. Musculoskeletal Pain

    • Costochondritis or trauma may cause localized chest pain without significant EKG changes.

  5. Anxiety or Panic Attack

    • Chest pain with normal EKG; often associated with hyperventilation.

Metabolic or Systemic Causes

  1. Electrolyte Imbalances

    • Potassium, calcium, or magnesium imbalances can cause arrhythmias or EKG changes (e.g., peaked T waves with hyperkalemia).

  2. Hypoxia or Anemia

    • Reduced oxygen delivery can lead to ischemic changes.

  3. Thyroid Disorders

    • Hyperthyroidism can cause tachycardia or atrial fibrillation.

  4. Drug Effects or Toxicity

    • Certain medications (e.g., digoxin, antiarrhythmics) or recreational drugs (e.g., cocaine) can affect EKG and cause chest pain.

  5. Infections or Sepsis

    • May lead to myocarditis or metabolic changes impacting the heart.

When to Seek Immediate Attention

  • Persistent or severe chest pain, especially if accompanied by shortness of breath, sweating, dizziness, or nausea, requires urgent medical evaluation.
  • Abnormal EKG findings in conjunction with symptoms like chest pain or palpitations should prompt evaluation by a healthcare provider.

Since you have a history of coronary calcification and mild hypertension, it's especially important to take chest pain seriously. Let me know if you'd like help interpreting any specific findings or symptoms.

 

 

Unstable Patient

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