DD Chest Pain

Chest pain dapat disebabkan oleh:

1. Cardiac cause
Karakteristik:
Pencetus: physical exertion
Anger
Other emotional excitement
Cold weather
Nyeri seperti tertekan (tightness, heaviness pain)
2. Pulmonary cause
Karakteristik:
Sharp pain (pleuritic pain)
Dicetuskan saat bernafas
3. Gastrointestinal cause
Karakteristik:
Dicetuskan oleh makanan tertentu
Unrelated to exertion
Burning pain
4. Musculoskeletal cause
Karakteristik:
More superficial or can be localize to a discrete spot (pasien dapat menunjuk
lokasi nyeri dengan 1 jari)

Table 13-2 Typical Clinical Features of Major Causes of Acute Chest Discomfort
Condition

Duration

Quality

Location

Associated
Features

Angina

More than 2

Pressure,

Retrosternal, often

and less than tightness,

with radiation to or

10 min

squeezing,

isolated discomfort in

heaviness,

neck, jaw, shoulders,

burning

or armsfrequently
on left

Precipitated by
exertion, exposure to
cold, psychologic
stress

Condition

Duration

Quality

Location

Associated
Features
S4 gallop or mitral
regurgitation
murmur during pain

Unstable angina

1020 min

Similar to

Similar to angina

Similar to angina,

angina but

but occurs with low

often more

levels of exertion or

severe

even at rest

Acute myocardial Variable;

Similar to

infarction

often more

angina but

than 30 min

often more

Similar to angina
Unrelieved by
nitroglycerin

severe

May be associated
with evidence of
heart failure or
arrhythmia

Aortic stenosis

Pericarditis

Recurrent

As described As described for

Late-peaking

episodes as

for angina

systolic murmur

angina

described for

radiating to carotid

angina

arteries

Hours to

Sharp

Retrosternal or

days; may be

toward cardiac apex;

episodic

may radiate to left

shoulder

May be relieved by
sitting up and
leaning forward
Pericardial friction
rub

Aortic dissection Abrupt onset Tearing or

Anterior chest, often

of unrelenting ripping

radiating to back,

pain

between shoulder

sensation;

Associated with
hypertension and/or

Condition

Duration

Quality

Location

Associated
Features

knifelike

blades
underlying
connective tissue
disorder, e.g.,
Marfan syndrome
Murmur of aortic
insufficiency,
pericardial rub,
pericardial
tamponade, or loss
of peripheral pulses

Pulmonary

Abrupt onset; Pleuritic

Often lateral, on the

embolism

several

side of the embolism tachycardia, and

minutes to a

Dyspnea, tachypnea,
hypotension

few hours
Pulmonary

Variable

Pressure

Substernal

hypertension

Dyspnea, signs of
increased venous
pressure including
edema and jugular
venous distention

Pneumonia or

Variable

Pleuritic

pleuritis

Unilateral, often

Dyspnea, cough,

localized

fever, rales,
occasional rub

Spontaneous

Sudden

pneumothorax

onset; several

Pleuritic

Lateral to side of

Dyspnea, decreased

pneumothorax

breath sounds on

hours

side of
pneumothorax

Esophageal reflux 1060 min

Burning

Substernal, epigastric
Worsened by

Condition

Duration

Quality

Location

Associated
Features
postprandial
recumbency
Relieved by antacids

Esophageal

230 min

spasm

Pressure,

Retrosternal

tightness,

Can closely mimic

angina

burning
Peptic ulcer

Prolonged

Burning

Epigastric, substernal Relieved with food

or antacids

Gallbladder

Prolonged

disease

Burning,

Epigastric, right

pressure

upper quadrant,

May follow meal

substernal
Musculoskeletal

Variable

Aching

Variable
Aggravated by

disease

movement
May be reproduced
by localized pressure
on examination
Herpes zoster

Variable

Sharp or

Dermatomal

Vesicular rash in

burning

distribution

area of discomfort

Emotional and

Variable; may Variable

Variable; may be

psychiatric

be fleeting

retrosternal

conditions

Situational factors
may precipitate
symptoms
Anxiety or
depression often
detectable with

Condition

Duration

Quality

Location

Associated
Features
careful history