S2D: The Symptom to Diagnosis Podcast Chest Pain
Mar 31, 2021
This discussion dives into the complexities of diagnosing chest pain, emphasizing the importance of differentiating between GERD and cardiac issues. A compelling case of a 70-year-old with nocturnal chest pain raises critical questions about prior stress tests. The hosts highlight the role of rapid EKGs and chest x-rays while pointing out the unique ways women present myocardial infarctions. They also tackle misconceptions around troponin tests in chronic kidney disease and stress the need for careful evaluations to avoid misdiagnosis.
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Nocturnal Chest Pain In A CKD Patient
- A 70-year-old man with stage 5 CKD had month-long nocturnal chest pain waking him after 3–4 hours of sleep.
- He denied dyspnea, diaphoresis, or dysphagia and described aching-squeezing pain that resolved when sitting up.
Obtain Immediate EKG And Consider Chest X‑Ray
- Get an EKG within 10 minutes for any patient who presents with acute chest pain, even in clinic.
- Also consider a chest x-ray early because it can reveal diagnoses you might otherwise miss.
Common Causes Of Chronic Chest Pain
- Chronic chest pain clinic differentials cluster around a few diagnoses: stable angina, GERD, musculoskeletal, psychiatric, and no diagnosis.
- Be prepared for diagnostic uncertainty and the reality that some patients remain undiagnosed.
