Chest Pain and Differential Diagnosis

Question
Submit a research paper in APA format regarding Chest Pain and Di8erential Diagnosis. The student is to pick any three (3) di8erential diagnoses that can be associated with chest pain and their approach in various clinical settings. Research paper due in week 5. See Rubric below Include the following components in your research paper: 1. Title Page 2. Introduction (general) 3. Mention research studies (at least three articles) that validate the information presented in your paper. (Publication date should be no more than five (5) years old). 4. Conclusion 5. References Page Criteria Rating Points Exemplary
Answer

1. Introduction
Differential diagnosis of chest pain is particularly difficult because of the variety of potential causes. It is generally assumed that the more severe the symptoms, the more serious the underlying condition, and thus the differential diagnosis tends to focus on life-threatening cardiac and non-cardiac causes. This is particularly the case in patients with acute onset of severe chest pain and/or other symptoms suggestive of myocardial ischemia. A working knowledge of cardiac and respiratory anatomy, together with an understanding of referral patterns from different regions of the chest, are valuable in formulating a differential diagnosis. This can then be refined by further history and examination; for example, the character and timing of the pain and any exacerbating or relieving factors. With acute pain, it may, however, be difficult to determine these features, and the patient may be too ill to provide a reliable history. In some cases, therefore, the history and examination may serve only to determine the severity and stability of the patient’s condition.
Chest pain is a symptom that is frequently encountered in the practice of emergency medicine. It may present with a variety of clinical conditions ranging from life-threatening diseases to benign ones. On the other hand, differential diagnosis involves differentiation of a condition from others which presents in a similar manner. Failure to do this frequently results in misdiagnosis of the condition, resulting in improper treatment. The aims of the differential diagnosis of chest pain are to exclude life-threatening conditions, determine the underlying cause of the symptoms, and find an accurate diagnosis. This may not always be achieved, and thus a unifying diagnosis is made when no specific organic etiology can be identified. This text will discuss the differential diagnosis of chest pain, working through the acute and chronic cases.
1.1. Definition of Chest Pain
Chest pain is one of the most common symptoms that bring an individual to the emergency department, outpatient clinic, or primary care office. While the majority of patients with chest pain do not have a serious illness, those who do are at risk of significant morbidity and mortality if not diagnosed and treated promptly and effectively. An efficient and directed approach to the patient with chest pain relies on a good understanding of the underlying pathophysiology of the various disease processes that may cause chest pain. It is also important to recognize that atypical presentation of a disease is more common than typical presentation. The mechanism of chest pain can be varied; from simple musculoskeletal discomfort to a life-threatening cardiac or pulmonary event. Chest pain is often categorized into cardiac and non-cardiac causes. However, it is perhaps more useful to classify the pain by the underlying mechanism. This approach allows a better understanding of the disease process and is more clinically relevant, especially as musculoskeletal and gastroesophageal chest pain can often mimic cardiac pain.
1.2. Importance of Differential Diagnosis
Non-cardiac chest pain (CP) can be defined as chest pain emanating from the chest that does not originate from the heart. This seems like a simple enough definition to understand, but in practice, it can be quite the opposite. The term “non-cardiac chest pain” seems to imply that it is chest pain that is not originating from the heart. This would lead one to believe that the origin of pain is musculoskeletal or that of a psychological cause. However, non-cardiac chest pain is defined by intent. It is chest pain that is free of known cardiac cause. This is an important concept to understand. There are many patients that suffer from CP that, in reality, is of known non-cardiac cause. One simple example is a patient with chest wall pain from a viral illness. Often times, this patient will undergo extensive testing or even unnecessary time admitted to the hospital because a cardiologist wants to rule out cardiac cause of the chest pain. A more serious example is the patient who is diagnosed with GERD that is confronted with an atypical presentation such as angina and is hospitalized with suspected unstable angina or MI. The term “non-cardiac chest pain” can sometimes lead to incorrect assumptions and thus lead to unnecessary testing or potentially harmful treatments for the patient’s true underlying cause of CP.
2. Common Causes of Chest Pain
2.1. Coronary Artery Disease
2.2. Gastroesophageal Reflux Disease
2.3. Pulmonary Embolism
2.4. Musculoskeletal Causes
2.5. Anxiety and Panic Disorders
3. Approach to Differential Diagnosis
3.1. History Taking
3.2. Physical Examination
3.3. Diagnostic Tests
3.3.1. Electrocardiogram (ECG)
3.3.2. Chest X-ray
3.3.3. Echocardiography
3.3.4. Stress Testing
3.3.5. Laboratory Tests
4. Differential Diagnosis 1: Coronary Artery Disease
4.1. Risk Factors
4.2. Clinical Presentation
4.3. Diagnostic Approach
5. Differential Diagnosis 2: Gastroesophageal Reflux Disease
5.1. Pathophysiology
5.2. Clinical Features
5.3. Diagnostic Evaluation
6. Differential Diagnosis 3: Pulmonary Embolism
6.1. Pathogenesis
6.2. Signs and Symptoms
6.3. Diagnostic Workup
7. Clinical Settings for Differential Diagnosis
7.1. Emergency Department
7.2. Primary Care Clinic
7.3. Cardiology Clinic
8. Research Studies on Chest Pain and Differential Diagnosis
8.1. Study 1: Title and Findings
8.2. Study 2: Title and Findings
8.3. Study 3: Title and Findings
9. Conclusion
10. References