1. Clinical examination of a Patient with Chest Pain

2. Differential diagnosis in patients with chest pain
Cardiac (MI, Angina pectoris, Pericarditis, AD)
Pulmonary causes (PE, Pneumothorax, pneumonia)
Psychosocial anxiety

3. Musculoskeletal (costochondritis, strain)
Gastrointestinal (GERD,E.spasm)
Nonspecific chest pain

4. PROPER HISTORY
EXAMINATION

5. GENERAL EXAMINATION
GENERAL APPEARANCE APPEARANCE-DISTRESSED/LEVINE SIGN
BUILT AND NOURISHMENT
PALLOR:EXACERBATE ANGINA/HEART FAILURE

6. ICTERUS
CYANOSIS
CLUBBING
OEDEMA- limb swelling( DVT-Pulmonary embolism)

7. LYMPHADENOPATHY
EXAMINE ALL LYMPH NODES

8. ARTERIAL PULSE RATE RHYTHM
CHARACTER-pulses paradoxes(constrictive pericarditis)
VOLUME
VESSEL WALL CONDITION-thickening-atherosclerosis
OTHERPERIPHERAL PULSATIONS

9. BLOOD PRESSURE Hypotension can occur in √ MI √Pericardial temponade
√PleuralEffusion√GI bleeding
BP both arms not equalAORTIC DISSECTION

10. RESPIRATORY RATE
14-16/min

11. JUGULAR VENOUS PULSE

13. ELEVATED
√ RIGHT VENTRICULAR INFARCTION
√ PULMONARY EMBOLISM
√CONSTRICTIVE PERICARDITIS

14. TEMPERATURE PYREXIA: FIRST 3 DAY AFTER MI
Fever suggest infectious cause
TEMPERATURE

15. HEAD –FOOT EXAMINATION
Xanthoma and xanthelasma
Arcus senilis
Deformity

16. INSPECTION
PALPATION
PERCUSSION
AUSCULTATION

17. INSPECTION SKIN-rash of shingles Signs of trauma /swelling
CVS-Any visible pulsations,JVP
RESPIRATORY-Movements of chest wall,position of trachea(*deviation away from side affected-Pneumothorax)

18. PALPATION Localised tenderness Hyperesthesia-Herpes Zoster
Crepitus-rib fracture
CVS-Apex beat,Thrills,Palpable s3/s4 ,any other palpable events

19. RESPIRATORY-position of trachea, respiratory movements(
Pneumothorax ),Vocal fremitus,Chest expansion

20. PERCUSSION
Pneumothoraxhyper resonant
Pneumoniadull

21. AUSCULTATION CVS S1/S2 S3/S4(MI-Audible s4) Murmurs(AD) RESPIRATORY
Breath sounds,vocal fremitus,pleural rub,crackles

22. EXAMINATION FINDINDS

23. MYOCARDIAL INFARCTION SIGNS
SIGNS OF SYMPATHETIC ACTIVATION
PALLOR
SWEATING
TACHYCARDIA
SIGNS OF VAGAL STIMULATION
VOMITING
BRADYCARDIA

24. MI
Abnormal vital signs (tachycardia, bradycardia, tachypnea, hypotension)
Signs of hypoperfusion (eg confusion, ashen color)
Shortness of breath
Asymmetric breath sounds or pulses
heart murmurs
Pulsus paradoxus > 10 mm Hg

25. AORTIC DISSECTION Clinical: HTN BP both arms not equal
distal pulses diminished
Murmur
cardiac tamponade
 Paraplegia.

26. RESPIRATORY CAUSE PLEURAL EFFUSION √dull on percussion
√ bronchial breathing sound
√ pleural rub
√ crackle

27. PULMONARY EMBOLISM Physical Examination Tachycardia, tachypnea
If severe, can get hypotension, syncope, and RV failure (↑JVP)

28. PNEUMOTHORAX Decreased expansion of chest decreased breath sounds
decreased tactile/vocal fremitus on side of pneumothorax
Hyperresonant percussion note
In tension pneumothorax tracheal deviation away from the side of the pneumothorax

29. MUSCULOSKELETAL CHEST PAIN
LOCAL TENDERNESS
ENHANCED BY EMOTION,COUGHING,SNEEZING

30. SKIN Rash Fever itcy skin burning sensation stabbing pain tingling
HERPES ZOSTER
Rash
Fever
itcy skin
burning sensation
stabbing pain
tingling

31. GIT CAUSES
Relief  antacid.

32. THANK U