Chest Pain, Dyspnea & Cyanosis: Differential Diagnosis

Chest Pain, Dyspnea, and Cyanosis

Semiology

• Type of pain
• Location
• Factors that trigger
• Length
• Relieving factors
• Associated symptoms
• Angina equivalents

Chest Pain

Cardiac Causes

• Coronary
  • Acute: Unstable angina, SICA
  • Chronic: Stable angina

History and Physical Examination

• History: diabetes mellitus (DM), hypertension, smoking, dyslipidemia, obesity, sedentary lifestyle
• Young patients: consider cocaine or stimulant use
• Semiology of the pain (character, radiation, timing)
• Physical examination: vital signs and initial cardiovascular assessment

Noncoronary Cardiac Causes

• Pericardium: pericarditis, tumors
• Inflammatory: myocarditis, valvular disease

Noncardiac Causes

• Respiratory
  • Upper airway: bronchitis, tracheitis, tumors
  • Lower respiratory tract: pneumonia, atelectasis, abscesses, tumors
  • Pleural disease
• Other causes: pneumothorax, stroke, tumor, empyema

Chest Wall and Traumatic Causes

• Trauma: fractures, bruises
• Atraumatic: inflammation, tumor

Cyanosis

• Central
  • Cardiac
    • ICC (heart failure): acute, chronic
    • EPA: acute pulmonary edema / fluid overload
    • Congenital: CIA, CIV, HTTP, Tetralogy

Noncardiac Central Causes

• Respiratory: VRA, VRB, pleural disease
• 'Not breathing' causes: mediastinal, metabolic

Peripheral Cyanosis

• Vascular (traumatic)
• Vascular section / ischemia
• Flattening of perfusion

Nontraumatic Peripheral Causes

• Cooling
• Vasoconstriction

Dyspnea

• Symptom: subjective sensation of shortness of breath (awareness of breathing)
• Not to be confused with signs (objective findings)

Respiratory Patterns

• Hyperpnea: increased rate and depth of respiration
• Tachypnea: rapid ventilation

Types of Breathlessness

Acute dyspnea:

• Anxiety
• Hyperventilation
• Asthma
• Chest trauma
• Pulmonary edema
• Pneumonia
• Spontaneous pneumothorax

Chronic dyspnea:

• Respiratory causes
• Cardiovascular causes
• Systemic: anemia
• Psychogenic / anxiety
• Detraining

Classification

• Cardiac dyspnea: ICC, SICA, pericardial disease
• Noncardiac dyspnea:
  • Chest wall
  • Traumatic: bruises, fractures, wounds
  • Atraumatic: tumors, inflammation

Respiratory and Neurologic Causes

Respiratory: laryngeal, bronchial, pulmonary, pleural

• Neurologic
  • Traumatic: TEC (moderate, severe)
  • Atraumatic: peripheral neuropathies (SNP, SGP, other PNP)

Scales for Symptoms

Visual Analog Scale

• 0 = None
• 10 = Maximum

Borg Scale

• 0 = No dyspnea
• 1 = Very mild
• 2 = Mild
• 3 = Moderate
• 5 = Severe
• 7 = Very severe
• 10 = Maximum