H & P:

​

Acute MI 

Chest pressure, radiates, dyspnea, nausea, diaphoresis, CVD risk factors 

GEN: Pallor, diaphoresis / CVS: Murmur, peripheral edema 

 

 

Aortic dissection 

Tearing pain, radiates, dyspnea, paresthesia, CVD risk factors 

CVS: ↑BP, asymmetric BP, murmur / PVS: Limb ischemia, asymmetric pulses 

 

 

Esophageal rupture 

Hx prolonged vomiting, Hx instrumentation 

GEN: Diaphoresis, subcutaneous emphysema / CVS: Crunching heart sound 

 

 

Pericarditis 

Sharp pleuritic pain, radiates, worse supine, recent infection, recent MI 

GEN: ↓BP, tachycardia, fever / CVS: ↑JVP, ↓S1/S2, pulsus paradoxus, rub 

 

 

Pneumothorax 

Dyspnea, sharp pleuritic pain, Hx trauma, Hx instrumentation 

GEN: Tachypnea, subcutaneous emphysema / RESP: ↓A/E, ↑percussion 

 

 

Pulmonary embolism 

SOB, pleuritic pain, hemoptysis, Sx, immobility, smoker, BCP, Ca, Hx DVT/PE 

GEN: Tachypnea, tachycardia / PVS: Leg edema, erythema, heat, tenderness 

 

 

Tamponade 

Sharp pleuritic pain, dyspnea, orthopnea, Hx trauma 

GEN: ↓BP, tachycardia, pallor, diaphoresis / CVS: ↑JVP, ↓S1/S2, pulsus paradoxus 

​

​

Investigation:

 

CBC, Lytes, Cr, BhCG, Trop, ECG, CXR, CT

​

- HEART Score

- PERC

- Well's

​

​

​

​

​

​

​

​

​

​