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Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
When a patient has chest discomfort caused by exertion and relieved by rest, the diagnosis of stable angina is likely. It is more accurate when significant risk factors for CAD are present. Patients are assessed for an acute coronary syndrome if their chest discomfort lasts for more than 20 minutes. It is important to understand that chest discomfort can also be caused by anxiety, panic attacks, costochondritis, GI disorders, and hyperventilation. ECG is performed, and for some cases, stress testing with ECG or myocardial imaging and coronary angiography may order. Myocardial imaging methods include echocardiography, MRI, and radionuclide imaging. The noninvasive tests are performed first.
Cardiology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Acute chest pain differentials include: Cardiac causes (angina, pericarditis, aortic dissection, heart failure), respiratory causes (pneumothorax, pneumonia, pulmonary embolism), trauma, musculoskeletal, gastrooesophageal reflux disease, costochondritis and anxiety.
Diagnosis of Chronic Fatigue Syndrome
Published in Jay A. Goldstein, Chronic Fatigue Syndromes, 2020
Cardiac complaints primarily concern arrhythmias, usually su-praventricular tachycardias. Although a large number of patients will have mitral valve prolapse, the role of this process in causing tachycardia in the CFS population is questionable. Some patients respond to beta blockers, but whether these treat a hyperadrenergic state rather than the myocardium or mitral valve is unclear. Primary myocardial disorders are uncommon in CFS although myocarditis does occur, usually viral. A limbic or paralimbic etiology for ar-rhythmias is much more attractive, particularly since these episodes may occur in the context of a panic disorder or what could be considered to be a forme fruste, e.g., “panic attack without anxiety.” Chest pain does not usually seem to be pulmonary or cardiac, although coronary artery spasm and microvascular angina should be considered. CFS chest pain is more often esophageal or myofascial. Some patients will have symptoms of pleurodynia intermittently without fever or friction rub and with a normal chest X ray. “Costochondritis” per se does not occur, since there is no swelling of the costochondral junction. Another way to make the diagnosis of this disorder is by the “crowing rooster” maneuver to put the costochondral junctions on stretch. If this test is negative, one can assume that costochondral tenderness is secondary to tenderness of the sternalis muscle, the function of which is obscure. Chest pain can be produced by hyperventilation.
Intra and inter observer agreement in the mobility assessment of the upper thoracic costovertebral joints
Published in Physiotherapy Theory and Practice, 2023
Michael Cibulka, Justin Buck, Bria Busta, Erika Neil, Drake Smith, Reece Triller
The result of this study, using the AC statistic, showed that the assessment of costovertebral mobility using P/A springing of the ribs is a reliable method for both between (inter) and within (intra) raters. Many of the skills that physical therapists learn rely on refining their manual or palpatory skills. This is especially important when assessing costovertebral (rib) mobility in patients with upper thoracic/lower cervical pain, thoracic outlet syndrome, or costochondritis. In a previous reliability study performed of observer agreement using rib palpation to assess costovertebral joint mobility, Heiderscheit and Boissonnault (2008) did not describe how they graded costovertebral mobility, nor was there any description of what defined the difference between abnormal rib mobility; hyper, hypo, or normal. An important part of achieving good observer agreement is to learn how to properly assess and differentiate grades of rib mobility. We believe the use of a model, in this case palpating different parts of the face, improved our reliability of assessing rib mobility. Moreover, using an experienced therapist instead of a student might have yielded even better results.
Systemic lupus erythematosus: a case-based presentation of renal, neurologic, and hematologic emergencies
Published in Expert Review of Clinical Immunology, 2018
Eric J. Campbell, Ann E. Clarke, Rosalind Ramsey-Goldman
A previously healthy 42-year-old African-American woman presents to the emergency department following a 2-month history of progressive exertional dyspnea, nonproductive cough, malaise, chest pain, bilateral leg swelling, and decreased appetite without weight loss. She was assessed 2 weeks prior in an urgent care center and was given diclofenac for presumed costochondritis, which she took for 5 days and then discontinued due to epigastric discomfort consistent with gastroesophageal reflux. Given her ongoing symptoms, she saw her primary care provider who was concerned about possible systemic illnesses, and so blood work was ordered with a planned follow up after the patient returned from an out-of-town trip visiting her family. However, her symptoms continued to worsen and she now presents to the emergency department.
Severe post-COVID-19 costochondritis in children
Published in Baylor University Medical Center Proceedings, 2022
Reagan A. Collins, Nandini Ray, Kelly Ratheal, Athos Colon
Costochondritis is a benign form of chest wall pain due to inflammation of the costal cartilages.4 Chest pain in children is generally not due to severe disease and occurs in patients with normal vital signs, labs, electrocardiograms, and chest x-rays.4–6 More severe forms of costochondritis can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, meloxicam, or ibuprofen.4,5 Though other causes of chest pain are rare in adolescents, it is imperative to exclude acute coronary syndrome, pneumothorax, pneumonia, aortic dissection, and pulmonary embolism, among others, using the history of present illness, review of systems, and medical workup prior to this diagnosis.4,5