The other day I was telling my students about how during the initial evaluation for chest pain, one often forgets to look for tender spots on the chest wall. Over the years I have had many admissions that turned out to be just benign chest wall pains and could have been avoided – if a thorough palpation of the chest wall can reproduce or worsen the chest pain the patient felt, MI is much less likely.
Common things are common but missing a critical cause of chest pain can mean death & lawsuits !! So giving the dangerous possibilities a quick thought while evaluating any chest pain is important – for that matter for any presenting symptom, it’s good clinical practice and protects both the patient and you. Not saying you need to pursue and rule out each of them with a million-dollar workup, but give it a thought and see if a differential can apply to the clinical context and presentation.
Here’s a mnemonic to mull over critical causes of acute chest pain, since missing it can mean DEATH!
D – Dissection of Aorta
E – Embolism (PE) + Esophageal Rupture
A – ACS (Acute Coronary Syndrome)
T – Tension PneumoThorax + Tamponade from Pericardial effusion
H – Hypertensive Urgency/Emergency
Am sure the mnemonic is ominous enough to remember easily ;). Or if your style is rather more bland and direct :p, here’s an alternative one: CHEST P
C – Coronary syndrome (ACS)
H – Hypertensive Emergency/Urgency
E – Esophageal Rupture
S – Splitting of Aorta (Dissection)
T – Tamponade of Pericardium, Tension Pneumothorax
P – Pulmonary Embolism (PE), Pneumothorax
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