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DDxPro
Possible Diagnoses
Pulmonary embolism
Pulmonary embolism
Hypoxemia
Dyspnea
Dyspnea at rest
Dyspnea with exertion
Tachypnea
Widened alveolar-arterial gradient for oxygen
Chest pain
Pleuritic chest pain
Breathlessness
Unexplained breathlessness
Bed rest
Chronic myeloproliferative neoplasms
Essential thrombocythemia
Polycythemia vera
Rales
Cough
Rapid onset dypsnea
Calf edema
Calf erythema
Calf swelling
Acute pericarditis
Acute pericarditis
Chest pain
Pleuritic chest pain
Pleuritic pain
Relieved by sits up and leans forward
Sharp chest pain
Pericardial friction rub
Radiation to trapezius
Sudden onset
Sudden onset chest pain
Substernal pain
Exacerbation by coughing
Exacerbation by inspiration
Sharp pain
Dull chest pain
Dull oppressive chest pain
Dull pain
Oppressive pain
Dialysis-associated pericarditis
Uremic pericarditis
Chest discomfort
Chronic heart failure
Chronic heart failure
Shortness of breath
Dyspnea on exertion
Fatigue
Dyspnea occurring in the recumbent position
Orthopnea
Relieved by sitting upright
Relieved by sleeping with additional pillows
Cool peripheral extremities
Cyanosis of the lips
Cyanosis of the nail beds
Dyspnea at rest
Dyspnea exacerbated in the supine position
Peripheral edema
Symmetric peripheral edema
Atherosclerotic
Cardiomyopathy
Dyspnea awaken the patient from sleep
Metabolic syndrome
Nocturnal cough
Paroxysmal nocturnal dyspnea
Anaphylaxis
Anaphylaxis
Conjunctival swelling
Generalized flushing
Generalized hives
Generalized pruritus
Intensely pruritic
Intensely pruritic urticarial eruptions
Involvement of the mucosal tissue
Involvement of the skin
Periorbital edema
Swollen lips
Swollen tongue
Swollen uvula
Urticarial eruptions
Uniphasic
Bronchospasm
Change in voice quality
Cough
Dyspnea
Hypoxemia
Nasal congestion
Myocardial infarction
St-elevation myocardial infarction
Diastolic blood pressure
Dyslipidemia
Metabolic syndrome
Physical inactivity
Prior coronary artery disease
Renal insufficiency
Systolic blood pressure
Chest aching
Chest discomfort
Chest pain
Chest pressure
Chest tightness
Retrosternal chest pain
Chest pain lasts for at least 20 minutes
Chest pain radiate to jaw
Chest pain radiate to left arm
Diffuse chest pain
Diffuse chest pain at rest
Diffuse chest pain with exertion
Severe chest pain
Non-st-elevation myocardial infarction
Atherosclerosis
Diabetes mellitus
Dyslipidemia
Hypertension
Metabolic syndrome
Chest aching
Chest discomfort at minimal exertion
Chest discomfort at rest
Chest pain
Chest pain radiate to both arms
Chest pain radiate to the back
Chest pain radiate to the epigastrium
Chest pain radiate to the left arm
Chest pain radiate to the lower jaw
Chest tightness
Retrosternal chest pain
Chest burning
Chest discomfort
Chest heaviness
Chest pressure
Cryptococcosis
Cryptococcosis
Immunosuppression
Dyspnea
Productive cough
Papilledema
Chest dullness to percussion
Chest pain
Crackles
Crackles on the affected side
Diminished breath sounds
Altered consciousness
Hiv infection
Brain involvement
Central nervous system involvement
Chills
Elevated opening pressure on lumber puncture
Endemic area living
Fever
Glucocorticoids
Lung disease
Meningitis
Sarcoidosis
Sarcoidosis
Lung involvement
Fatigue
Asymptomatic bilateral hilar adenopathy
Lofgren syndrome
Eye lesions
Joint lesions
Skin lesions
Diffuse interstitial lung disease
Cough
Dyspnea
Dry eyes
Migratory polyarthralgia
Painful nodules on the anterior surface of the lower extremities
Palpitations
Fever
Weight loss
Chest pain
Malaise
Erythema nodosum
Heerfordt syndrome
Adrenal crisis
Adrenal crisis
Shock
Abdominal pain
Back pain
Flank pain
Lower chest pain
Weakness
Meningococcemia
Circulatory failure
Hypovolemic shock
Vasodilatory shock
Fever
Primary adrenal insufficiency
Generalized tenderness
Fatigue
Lethargy
Anticoagulant
Antiphospholipid syndrome
Coagulopathy
Cytomegalovirus infection
Dehydration
Aortic coarctation
Aortic coarctation
Absent femoral pulse
Absent lower extremity pulses
Delayed femoral pulse
Delayed femoral pulses
Diminished lower extremity pulses
Low arterial blood pressure in the lower extremities
Unobtainable arterial blood pressure in the lower extremities
Continuous murmur
Murmur
Systolic ejection murmur
Systolic murmur
Hypertension
Upper extremity hypertension
Broad chest
Shield-shape chest
Short height
Widely spaced nipples
Bicuspid aortic valve
Cardiovascular malformation
Ventricular septal defect
Pheochromocytoma
Pheochromocytoma
Episodic headache
Sweating
Tachycardia
Paroxysmal hypertension
Forceful palpitations
Abdominal pain
Chest pain
Diarrhea
Dyspnea
Fatigue
Generalized weakness
Hyperadrenergic spells
Multiple endocrine neoplasia type 2
Pallor
Panic attack-type symptoms
Paradoxical response to antihypertensive drugs
Pressor response during anesthesia
Pressor response during angiography
Pressor response during surgery
Primary hypertension
Eclampsia
Eclampsia
Hypertension
Frontal headaches
Headache
Occipital headaches
Thunderclap headaches
Preexisting preeclampsia
After 20 weeks of gestation
Blurred vision
Decreased visual acuity
Flashing lights
Flashing sparks
Headaches
Scotomata
Visual loss
Symptoms of cns dysfunction
Altered mental status
Cerebral symptoms
Confusion
Cortical blindness
Hepatic abnormality
Noncardiac Chest Pain
History, Physical examination
Trial of Double Dose of PPI bid X 14 Days
Response by PPI
Treat for GERD
No response by PPI
Endoscopy
Structural or mucosal abnormality
Esophageal cause of chest pain likely
Treat Accordingly
Normal Endoscopy
24-hr pH monitoring
Normal pH
Manometry
Diffuse esophageal spasm, Achalasia, Nutcracker esophagus
Esophageal cause of chest pain likely
Treat Accordingly
Normal study or nonspecific motility disorder
Provocative Testing: Bernstein Tensilar Balloon Distention
Normal Provocative Testing
Chest pain in Provocative Testing
Consider Trial of a Tricyclic Antidepressant
PH <4 but no correlation with chest pain
Possible esophageal (GERD) cause of chest pain
Empiric Trial of Treatment for GERD
Chest pain correlating with pH <4
Esophageal (GERD) cause of chest pain
Treat for GERD
Stable Angina
H / PE
Unstable
Refer for acute care
Stable
Assess prognosis
Adequate information on prognosis available?
Yes
High-risk findings?
Yes
Consider cardiac catheterization
Anatomy consistent with superior outcome with CABG
Yes
Surgical candidate?
No
Revascularization for Symptoms/High-Risk PCI
No
Assess severity of symptoms
Mild/moderate/severe symptoms
Pharmacologic Therapy for Symptoms: Beta Blocker, Calcium Agonist, Nitrate, Nitroglycerin
Reassess symptoms
None
Continue management of risk factors
No
Stress test (exercise or pharmacologic? with or without imaging)
Assess LV function
High-risk findings?
Yes
Consider cardiac catheterization
Anatomy consistent with superior outcome with CABG
No
Assess severity of symptoms
Mild/moderate/severe symptoms
None
Assess severity of symptoms
Mild/moderate/severe symptoms
Pharmacologic Therapy for Symptoms: Beta Blocker, Calcium Agonist, Nitrate, Nitroglycerin
Reassess symptoms
Refractory
Consider cardiac catheterization
Anatomy consistent with superior outcome with CABG
Yes
Surgical candidate?
No
Revascularization for Symptoms/High-Risk PCI
Improved
Continue management of risk factors
None
Continue management of risk factors
Assess risk factors
Risk Factor Modification: Behavioral, Pharmacologic:
Continue management of risk factors
ECG and laboratory testing:
Correct exacerbating conditions
Unstable Angina
H / PE, 12-lead ECG, Cardiac biomarkers
Likelihood of UA/NSTEMI
High likelihood: Typical angina, Known history of CAD or MI, CHF, New ECG changes, Positive CKMB or troponin
Hospitalize
Aspirin, Heparin (UFH/LMWH), Clopidogrel, Beta Blockers, Nitrates, Statins
Risk stratify
Moderate to high risk: Read Note.
Glycoprotein Ilb/Illa Inhibitor, Early Catheterization
Long-Term Care: Risk Factor Modification, Aspirin, Clopidogrel Beta Blockers, High-Dose Statins, ACE Inhibitors/ARBs
Low risk: Normal CKMB or troponin, No ECG changes, TIMI Risk Score <3
Catheterization if: Recurrent Ischemia, CHF, Positive ETT, Hemodynamic Instability, Serious Arrhythmia
Glycoprotein Ilb/Illa Inhibitor, Early Catheterization
Long-Term Care: Risk Factor Modification, Aspirin, Clopidogrel Beta Blockers, High-Dose Statins, ACE Inhibitors/ARBs
Predischarge Stress Test
Long-Term Care: Risk Factor Modification, Aspirin, Clopidogrel Beta Blockers, High-Dose Statins, ACE Inhibitors/ARBs
Intermediate likelihood: Probable angina, Age >70 yr, Diabetes, History of PVD or cerebrovascular accident, Old ECG changes
Hospitalize
Aspirin, Heparin (UFH/LMWH), Clopidogrel, Beta Blockers, Nitrates, Statins
Risk stratify
Moderate to high risk: Read Note.
Glycoprotein Ilb/Illa Inhibitor, Early Catheterization
Long-Term Care: Risk Factor Modification, Aspirin, Clopidogrel Beta Blockers, High-Dose Statins, ACE Inhibitors/ARBs
Low risk: Normal CKMB or troponin, No ECG changes, TIMI Risk Score <3
Catheterization if: Recurrent Ischemia, CHF, Positive ETT, Hemodynamic Instability, Serious Arrhythmia
Glycoprotein Ilb/Illa Inhibitor, Early Catheterization
Long-Term Care: Risk Factor Modification, Aspirin, Clopidogrel Beta Blockers, High-Dose Statins, ACE Inhibitors/ARBs
Predischarge Stress Test
Long-Term Care: Risk Factor Modification, Aspirin, Clopidogrel Beta Blockers, High-Dose Statins, ACE Inhibitors/ARBs
Low likelihood: Atypical angina, Reproducible, No cardiac risk factors, Normal ECG
Evaluate as outpatient
Aspirin, Risk Factor Modification, Stress Test