Pre PACES Podcast #93 Chest pain
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Aug 4, 2024 In this engaging discussion, Dr. Retesh Bajaj, an interventional cardiologist and PACES instructor, teams up with Dr. Bunny Saberwal, also an interventional cardiologist with a focus on Intelligent PACES. They dive into the complexities of chest pain, covering acute coronary syndromes, historical features that reduce ACS probability, and the pitfalls of misdiagnosing aortic dissection. Their insights on pleuritic pain, mimics of cardiac issues, and the role of echocardiography provide valuable knowledge for both clinical practice and exam preparation.
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Don't Rely On Classic Dissection Signs
- Classic textbook signs of dissection (tearing pain, unequal pulses) are unreliable.
- Maintain low threshold for CT aortogram when suspicion exists because tests like pulses are not sensitive.
Use Palpation To Identify Musculoskeletal Pain
- Palpation that reproduces exquisite chest-wall tenderness strongly suggests costochondritis.
- Use reproducible focal tenderness plus history to deprioritize ACS when ECG and vitals are benign.
Use Pain Duration To Guide Risk
- Ask how long the pain lasted; pains lasting ≥20 minutes are more likely to cause troponin rise.
- Use duration (>20 min) to judge need for CCU/monitoring versus outpatient workup.