Patient Assessment
Chest pain
Headache
Abdominal pain
Shortness of breath
Fever
Dizziness
Gradual onset
Sudden onset
Intermittent
Progressive
Worsening
Improving
Radiating pain
Sharp pain
Dull ache
Throbbing
Hypertension
Diabetes
Asthma
Heart disease
No significant history
No known allergies
Penicillin allergy
Aspirin
Metformin
Normal vital signs
Tachycardia
Hypertensive
Afebrile
Febrile
Tenderness
Normal cardiac exam
Clear lungs
ECG ordered
CBC normal
CXR pending
Elevated troponin
CT scan ordered
Differential Diagnosis
DP
Diagnosis Pro
Differential Diagnosis Specialist
๐ฉบ Potential Diagnoses
-
Myocardial InfarctionConfidence: 78%Based on chest pain characteristics, ECG changes, and elevated cardiac enzymes.
-
Pulmonary EmbolismConfidence: 65%Consider if patient has risk factors for DVT, pleuritic chest pain, or hypoxia.
-
Aortic DissectionConfidence: 45%Suspect if tearing chest pain radiating to back, pulse deficits, or hypertension.
๐ Recommended Investigations
- Cardiac enzymes (troponin, CK-MB)
- ECG - repeat in 4-6 hours
- Chest X-ray
- D-dimer if low probability PE
- CT angiography if high probability PE
๐ Initial Management
- Aspirin 325 mg chewed
- Nitroglycerin SL if BP > 100 mmHg
- Morphine for pain control
- Oxygen to maintain SpO2 > 90%
- Consider beta-blocker if no contraindications
๐ Evidence & References
UpToDate: Acute Coronary Syndromes
PubMed: #32568974
ACC/AHA Guidelines 2023
Cochrane Review: Antiplatelet Therapy