University of Iowa



Learning Objectives:

• Define the accuracy of the initial EKG, labs, etc., in the diagnosis of cardiac disease in the ED or office

• Define the role and significance (or lack thereof) of risk factors such as diabetes, family history, smoking and hypertension in the decision of whether or not to admit a patient for cardiac disease

• Define the roles of various diagnostic tests in the diagnosis of possible pulmonary embolism

• Discuss the differential diagnosis of chest pain

Suggested Readings:

Green LA, Rodgers PE, Chest Pain (Chapter 9). In: Sloan PD, Slatt LM, Ebell MH, Smith MA, eds. Essentials of Family Medicine, 6th ed. Philadelphia, PA: Wolters Kluwer/Lippincott, Williams and Wilkins, 2012, 99-112.

Panju AA, et al.  Is This Patient Having a Myocardial Infarction?  JAMA 1998;280:1256-63. (verified 06/20/12)

Ebell, MH, Evaluation of Chest Pain in Primary Care Patients. Am Fam Physician.  2011 Mar 1; 83 (5):603-605. (verified 06/20/12)

CASE 2

55 year old man with no prior history of cardiac disease presents stating he feels as though he is going to die.  He notes chest pain that reached a maximum intensity about 10 minutes after it started.  It is described as a pressure that radiates to his left arm.  He complains of dyspnea, is diaphoretic and appears in distress.  He has a long history of smoking and hypertension but a negative family history.  When questioned, the patient notes that he also has a past history of depression but has been fine for the past 10 years or so.  His job is stressful but no more than usual, and he usually handles things pretty well.  His blood pressure is 142/94.  02 saturation is 97% on room air and his pulse is about 130. His pain is not reproducible. 

Question 1: What signs and symptoms does this patient display that are consistent with cardiac

disease?

Question 2: What signs and symptoms does this patient have that are associated with panic

disorder?

Question 3: What would you do for this patient?

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