CASE:

A 40-year-old male smoker complains of non-radiating chest discomfort

precipitated by effort, lasting for around 2 minutes, relieved spontaneously
by rest for the past 3 days.  However, he was rushed to the emergency
room due to increasing frequency of chest discomfort, lasting for around 20
minutes during the last hour, with accompanying diaphoresis. 
Questions
1.  List down possible causes/differential diagnosis of the patient’s
condition
Possible causes/differential diagnosis are Acute Coronary Syndrome, acute
aortic syndrome, pulmonary embolism, tension pneumothorax, pericarditis
with tamponade and esophageal rupture
 
 
2.  Differentiate the following based on risk factors, duration of pain,
radiation of pain, aggravating factors, relieving factors.
 Risk Duration of Aggravatin Relieving
Condition Radiation
factors pain g factors factors
abdominal
obesity,
pregnancy,
gastric
hypersecretor
pregnancy,
y states,
obesity, Substernal, Relieved by
GERD tobacco
10–60 min
epigastric
delayed
antacids
gastric
smoking
emptying,
disruption of
esopha- geal
peristalsis,
and gluttony.

Retrosternal,
Precipitated
often with
by exertion,
Obesity, radiation to or
more than 2 exposure to Rest
Stable Dyslipidemia, isolated
and less than cold, Medications
angina smoking,
10 min
discomfort in
psychologic ( nitrates)
diabetes neck, jaw,
stress induces
shoulders, or
tachycardia
arms

Familial Psychological Medications

Retrosternal, stress
history of (antihypertens
often with
heard disease, ives, anti-
radiation to or
sedentary lipemic
Unstable isolated
lifestyle, 10–20 min agents),
angina anemia,
discomfort in
Percutaneous
neck, jaw,
hypertension, transluminal
shoulders, or
metabolic coronary
arms
syndrome angioplasy

pain in
Anterior
chest, often
radiating to
Hypertenson, Abrupt onset Increased Blood
Aortic back, between
atherosclerosi of unrelenting Blood pressure
dissection s pain
shoulder
Pressure control
blades, back
pain between
the shoulder
blades