An update to this arcticle is pending.
Disease | Differentiating signs and symptoms |
---|---|
Aortic dissection Aortic Aneurysm and Dissection | Sudden intense chest pain Blood pressure may be low and pulses asymmetrical New-onset aortic valve regurgitation Dissection may obstruct the origins of coronary arteries with signs of impending infarction Broad mediastinum on chest x-ray |
Acute pulmonary embolism Pulmonary Embolism | Dyspnoea and tachypnoea as the principal symptoms Chest pain in about half of patients Tachycardia, RBBB, low blood pressure in extensive pulmonary embolism; echocardiography shows right-sided dilatation and increased pulmonary pressure Chest x-ray is often normal PaO2 decreased or normal, PaCO2 decreased or normal D-dimer assay positive; negative result excludes pulmonary embolism with high probability |
Spontaneous pneumothorax, tension pneumothorax Pneumothorax | Dyspnoea, chest pain Quiet breath signs on auscultation Chest x-ray will confirm diagnosis |
Oesophageal tear, perforated ulcer Peptic Ulcer Disease, Helicobacter Pylori Infection and Chronic Gastritis | Chest pain, upper abdominal pain |
Pericarditis Pericarditis, myocarditis Myocarditis | Pain is usually retrosternal and is sharp or tearing in nature The pain is aggravated by inspiration, coughing and changing of position A friction rub may be heard ST-T changes with almost daily alternations |
Pleuritis Pleural Effusions and Thoracentesis | Signs and symptoms of respiratory tract infection Stabbing chest pain, aggravated by inspiration and coughing |
Costochondral pain Tietze's Syndrome and Costochondritis | Pain on palpation Chest wall movements and breathing may aggravate the pain |
Oesophageal inflammationGastro-Oesophageal Reflux Disease or spasm, dyspepsia Dyspepsia | Heartburn, chest pain, upper abdominal pain May be worse in recumbent position and on exertion (reflux) No ECG changes Relief from PPIs |
Early herpes zoster Shingles (Herpes Zoster) | No ECG changes Rash appears within a few days Localised paraesthesia before the appearance of the rash |
Hyperventilation syndrome Hyperventilation | Strong feeling of lack of air Fast and deep breathing Cold limbs with tingling and numbness Dizziness, headache, dry mouth PaCO2 decreased, PaO2 increased or normal |
Depression Recognition and Diagnostics of Depression | Continuous feeling of heaviness in the chest, no correlation to exercise ECG normal |
ECG changes associated with prior Q wave myocardial infarction - an adaptation of the recommendations by the joint ESC/ACCF/AHA/WHF task force | |
---|---|
1 | Any Q wave in leads V2-V3 ≥ 20 ms or QS complex in leads V2 and V3 |
2 | Q wave ≥ 30ms and ≥ 1 mV deep or QS complex in leads I, II, aVL, aVF or V4-V6 in at least two leads of a contiguous lead grouping (which are I, aVL; V1-V6; II, III, aVF, and V7-V9) |
3 | R wave ≥ 40 ms in V1-V2 and R/S ratio ≥ 1 with a concordant positive T wave in the absence of a conduction defect |
Adapted from:Eur Heart J 2012;33:2551-2567. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Conditions to be considered in the differential diagnosis of an MI when interpreting ECG changes
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Source: Porela, Ilva. Sepelvaltimotautikohtauksen diagnostiikka ja epidemiologia (Diagnosis and epidemiology of acute coronary syndrome, In Finnish). In: Airaksinen et al. (eds.) Kardiologia, Kustannus Oy Duodecim, 2016, p. 392. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ECG diagnosis: UA and non ST elevation myocardial infarction (NSTEMI)
ECG diagnosis: ST elevation myocardial infarction
Special remarks
Cardiac biomarkers
Initial management Oxygen Therapy for Acute Myocardial Infarction
Treatment of UA and NSTEMI
Short-term risk stratification in UA and NSTEMI
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Modified from: Eskola et al. Epävakaa angina pectoris ja sydäninfarkti ilman ST-nousua (NSTEMI): vaaran arviointi ja ennuste. [Unstable angina pectoris and non-ST elevation myocardial infarction (NSTEMI): assessment of danger and prognosis] (In Finnish). Publication: Airaksinen et al. (ed.) Kardiologia. Duodecim Publishing Company Ltd., 2016, p. 404. *The timing of angiography indicated in the table is in accordance with the most recent European guideline. It is important to follow the guidelines locally agreed on. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Antithrombotic therapy Fondaparinux for Acute Coronary Syndromes
Anti-ischaemic and other treatment Statins for Acute Coronary Syndrome, Early Treatment with ACE Inhibitors in Acute Myocardial Infarction
Invasive treatment, revascularization (PTCA and CABG)
Treatment of STEMI
Initial management
Reperfusion: emergency percutaneous coronary intervention (PCI) / thrombolytic therapy? Complete Versus Culprit-Only Revascularization in ST-Elevation Myocardial Infarction
Contraindications to thrombolytic therapy in STEMI
Agents used in thrombolytic therapy
Other medication in association with reperfusion Low-Molecular Weight Heparin in Patients with Acute Myocardial Infarction Treated with Thrombolytic Therapy
Complications of thrombolytic therapy
Assessment of revascularization
Arrhythmias in the acute phaseCauses
Ventricular fibrillation (VF)
Ventricular tachycardia (VT)
Other ventricular arrhythmias
Atrial fibrillation (AF)
Sinus bradycardia and AV conduction disturbances
Antiarrhythmic medication
Intravenous doses of antiarrhythmic and antibradycardia medications
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from the source: Eur Heart J 2008;29:2909-2945 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Right ventricular infarction
Symptoms and diagnosis
Treatment
Acute coronary syndrome triggered by other factors
Inpatient treatmentMonitoring and care
Follow-up management
References
|