This presentation is the property of the Milwaukee County EMS Education Center. Any reproduction or use of this presentation without expressed permission is prohibited. Andrew Irzyk 2015 MCEMS Differential Diagnosis of Chest Pain

ó There are literally dozens of illnesses, injuries and conditions that can cause chest pain.

ó Knowing common signs, symptoms and patient presentations can help you differentiate between different kinds of chest pain.

ó Bottom Line: If you are ever not sure what kind of chest pain you are dealing with, treat it as cardiac and call medical control. Differential Diagnosis of Chest Pain Common Causes of Chest Pain

Cardiovascular: Respiratory:

ó ischemia (AMI or ó PE (pulmonary angina) embolism) ó pericarditis (irritation ó pneumothorax of pericardium) ó pneumonia ó thoracic aortic ó pleural irritation dissection ó hyperventilation (anxiety) Differential Diagnosis of Chest Pain Common Causes of Chest Pain

Gastrointestinal: Musculoskeletal: ó cholecystitis (gall ó chest wall syndrome bladder/gallstones) (inflamed chest wall) ó pancreatitis ó costochondritis (inflamed ó hiatal hernia (part of stomach pushes through rib cartilage) diaphragm) ó herpes zoster (shingles) ó esophageal disease/GERD ó chest wall trauma ó peptic ulcers ó chest wall tumors ó dyspepsia (indigestion) Non Cardiac Chest Pain ó Pulmonary ó Musculoskeletal ó Pneumonia ó Costochondritis ó Pleuritis ó Cervical Disk Disease ó Pneumothorax ó Rib Fracture ó Pulmonary Embolism ó Intercostal Muscle Cramp ó Tumor ó Other ó Gastrointestinal ó Herpes Zoster ó GERD ó Disorders of the Breast ó Esophageal spasm ó Splenic Infarct ó Mallory-Weiss Tear ó Panic Attacks/Anxiety ó Peptic Ulcer disease Disorder ó Biliary/Gallbladder ó Fibromyalgia Disease ó DKA ó Pancreatitis CHEST PAIN QUESTIONS TO HELP DIFFERENTIATE CHEST PAIN •CAUSE •ONSET OF PAIN •CHARACTERISTIC OF PAIN •LOCATION OF PAIN •HISTORY •ASSOCIATED SX/SX •AGGRAVATING FACTORS •RELIEVING FACTORS DETERMINE ONSET/DURATION OF PAIN Was it…

Sudden? Gradual? Lasts Minutes? Lasts Hours? Varies? Assessment “QUALITY” OF PAIN LOCATION

ó PLEURITIC (sharp pain with inhalation) ó SITUATIONAL / ANXIETY ó SPASMODIC (like a spasm) ó SUBSTERNAL ó ó TIGHTNESS OR HEAVINESS CENTER OR ACROSS CHEST ó LATERAL CHEST ó PRESSURE ó LOCALIZED OVER INVOLVED ó SHARP/LOCALIZED (easy to pinpoint) AREA ó VISCERAL (hard to pinpoint)/BURNING ó LOWER CHEST/EPIGASTRIC ó RADIATES TO JAW, NECK, BACK ó TEARING / EXCRUCIATING OR ARM ó VAGUE Visceral Pain

ó Visceral fibers enter the spinal cord at several levels leading to poorly localized, poorly characterized pain. (discomfort, heaviness, dull, aching) ó Heart, blood vessels, esophagus and visceral pleura are innervated by visceral fibers ó Because of dorsal fibers can overlap three levels above or below, disease of thoracic origin can produce pain anywhere from the jaw to the epigastrium

Parietal Pain

ó Parietal pain, in contrast to visceral pain, is described as sharp and can be localized to the dermatome superficial to the site of the painful stimulus. ó The dermis and parietal pleura are innervated by parietal fibers. Assessment History Associated Signs/Symptoms ó AGE ó DYSPNEA ó DIAPHORESIS ó PREVIOUS EPISODES ó NAUSEA / VOMITING ó UPPER RESPIRATORY ó AMS /WEAKNESS /LIGHTHEADEDNESS / INFECTION/FEVER SYNCOPE ó NEURO CHANGES ó TRAUMA ó HYPO OR HYPERTENSION OR UNEQUAL BP ó STRESS ó DECREASED OR ABNORNMAL BREATH SOUNDS ó EMOTIONAL UPSET ó CYANOSIS ó HEMOPTYSIS (coughing up blood) ó CARDIAC DISEASE ó PULSATING ABD MASS ó HTN, CAD, ANGINA ó ABDOMINAL PAIN ó PHLEBITIS ó VESICULAR PAIN WITH PALPATION ó RASH OR LESIONS Assessment AGGRAVATING FACTORS? RELIEVING FACTORS ó BREATHING ó REST OR DECREASED ó MOVEMENT MOVEMENT ó STRESS ó POSITION ó EXERTION ó SITTING UP OR LEANING ó AFTER EATING OR ETOH FORWARD ó ó LAYING DOWN DECREASED OR SHALLOW BREATHING ó DIET ó ANTACIDS ó MEDICATIONS Now lets match the chest pain diagnosis with the symptoms….

The list items in red italics are the ones that go with the diagnosis…. ANGINA ONSET/DURATION OF PAIN

ó Sudden ó Gradual ó Lasts Minutes ó Lasts Hours ó Varies Angina QUALITY LOCATION ó PLEURITIC ó SUBSTERNAL ó SPASMODIC ó CENTER OR ACROSS CHEST ó TIGHTNESS OR HEAVINESS ó LATERAL CHEST ó PRESSURE- OPPRESSIVE ó LOCALIZED OVER INVOLVED AREA ó SHARP/LOCALIZED ó LOWER CHEST/EPIGASTRIC VISCERAL /BURNING ó RADIATES TO JAW, ó TEARING / EXCRUCIATING NECK, BACK OR ARM ó VAGUE Angina

HISTORY ASSOCIATED SX / SX ó AGE ó DYSPNEA ó PREVIOUS EPISODES ó DIAPHORESIS ó NAUSEA / VOMITING ó UPPER RESPIRATORY ó AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE INFECTION/FEVER ó NEURO CHANGES ó TRAUMA ó HYPO OR HYPERTENSION OR UNEQUAL BP ó STRESS ó DECREASED OR ABNORNMAL BREATH SOUNDS ó EMOTIONAL UPSET ó CYANOSIS ó HEMOPTYSIS ó CARDIAC DISEASE – HTN, CAD, ó PULSATING ABD MASS ANGINA ó ABDOMINAL PAIN ó PHLEBITIS ó VESICULAR PAIN WITH PALPATION ó RASH OR LESIONS Angina AGGRAVATING FACTORS RELIEVING FACTORS ó BREATHING ó REST OR DECREASED MOVEMENT ó MOVEMENT ó POSITION ó STRESS ó SITTING UP OR LEANING FORWARD ó EXERTION ó DECREASED OR SHALLOW ó AFTER EATING OR ETOH BREATHING ó LAYING DOWN ó DIET ó SITUATIONAL / ANXIETY ó MEDICATIONS (nitro) Acute Myocardial Infarction ONSET/DURATION OF PAIN

ó Sudden ó Gradual ó Lasts Minutes ó Lasts Hours ó Varies Acute Myocardial Infarction

QUALITY LOCATION ó PLEURITIC ó SUBSTERNAL ó SPASMODIC ó CENTER OR ACROSS CHEST ó TIGHTNESS OR HEAVINESS ó LATERAL CHEST ó PRESSURE- OPPRESSIVE ó LOCALIZED OVER INVOLVED AREA ó SHARP/LOCALIZED ó LOWER CHEST/EPIGASTRIC VISCERAL/BURNING ó RADIATES TO JAW, ó TEARING / EXCRUCIATING NECK, BACK OR ARM ó VAGUE Acute Myocardial Infarction

HISTORY ASSOCIATED SX / SX ó AGE ó DYSPNEA ó PREVIOUS EPISODES ó DIAPHORESIS ó UPPER RESPIRATORY ó NAUSEA / VOMITING INFECTION/FEVER ó AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE ó TRAUMA ó NEURO CHANGES ó STRESS ó HYPO OR HYPERTENSION OR UNEQUAL BP ó EMOTIONAL UPSET ó DECREASED OR ABNORNMAL BREATH SOUNDS ó CARDIAC DISEASE – HTN, CAD, ó CYANOSIS ANGINA ó HEMOPTYSIS ó PULSATING ABD MASS ó PHLEBITIS ó ABDOMINAL PAIN ó VESICULAR PAIN WITH PALPATION ó RASH OR LESIONS Acute Myocardial Infarction

AGGRAVATING FACTORS RELIEVING FACTORS ó BREATHING ó REST OR DECREASED MOVEMENT ó MOVEMENT ó POSITION ó STRESS ó SITTING UP OR LEANING FORWARD ó EXERTION ó DECREASED OR SHALLOW ó AFTER EATING OR ETOH BREATHING ó LAYING DOWN ó DIET ó SITUATIONAL / ANXIETY ó ANTACIDS ó MEDICATIONS Operational Policy: Transport Destination Operational Policy: Transport Destination Dissecting Aneurysm ONSET/DURATION OF PAIN

ó Sudden ó Gradual ó Lasts Minutes ó Lasts Hours ó Varies Dissecting Aneurysm

QUALITY LOCATION ó PLEURITIC ó SUBSTERNAL ó SPASMODIC ó CENTER OR ACROSS CHEST ó TIGHTNESS OR HEAVINESS ó LATERAL CHEST ó PRESSURE- OPPRESSIVE ó LOCALIZED OVER INVOLVED AREA ó LOWER CHEST/EPIGASTRIC ó SHARP/ LOCALIZED VISCERAL/BURNING ó RADIATES TO JAW, NECK, BACK OR ARM ó TEARING / EXCRUCIATING ó VAGUE ó ABDOMEN

Aortic dissection Dissecting Aneurysm

HISTORY ASSOCIATED SX / SX ó AGE ó DYSPNEA ó DIAPHORESIS ó PREVIOUS EPISODES ó NAUSEA / VOMITING ó UPPER RESPIRATORY ó AMS /WEAKNESS / LIGHTHEADEDNESS / INFECTION/FEVER SYNCOPE ó NEURO CHANGES ó TRAUMA ó HYPO OR HYPERTENSION OR UNEQUAL BP ó STRESS ó DECREASED OR ABNORNMAL BREATH SOUNDS ó CYANOSIS ó EMOTIONAL UPSET ó HEMOPTYSIS ó CARDIAC DISEASE – HTN, CAD, ó PULSATING ABD MASS ANGINA ó ABDOMINAL PAIN ó VESICULAR PAIN WITH PALPATION ó PHLEBITIS ó RASH OR LESIONS Dissecting Aneurysm AGGRAVATING FACTORS ó BREATHING ó MOVEMENT ó STRESS ó In other words, it ó EXERTION hurts badly no ó AFTER EATING OR matter what. ETOH ó LAYING DOWN ó SITUATIONAL / ANXIETY Dissecting Aneurysm RELIEVING FACTORS

ó REST OR DECREASED MOVEMENT ó POSITION ó In other words, ó SITTING UP OR nothing helps it feel LEANING FORWARD better. ó DECREASED OR SHALLOW BREATHING ó DIET ó ANTACIDS ó MEDICATIONS PERICARDITIS ONSET/DURATION OF PAIN

ó Sudden ó Gradual ó Lasts Minutes ó Lasts Hours ó Varies PERICARDITIS

QUALITY LOCATION ó PLEURITIC ó SUBSTERNAL ó SPASMODIC ó CENTER OR ACROSS CHEST/RETROSTERNAL ó TIGHTNESS OR HEAVINESS ó LATERAL CHEST ó PRESSURE- OPPRESSIVE ó LOCALIZED OVER INVOLVED AREA ó SHARP/LOCALIZED ó LOWER CHEST/EPIGASTRIC VISCERAL/BURNING ó RADIATES TO JAW, ó TEARING / EXCRUCIATING NECK, BACK OR ARM ó VAGUE PERICARDITIS

HISTORY ASSOCIATED SX / SX ó AGE ó DYSPNEA ó PREVIOUS EPISODES ó DIAPHORESIS ó NAUSEA / VOMITING ó UPPER RESPIRATORY INFECTION/FEVER ó AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE ó TRAUMA ó NEURO CHANGES ó STRESS ó HYPO OR HYPERTENSION OR UNEQUAL BP ó EMOTIONAL UPSET ó DECREASED OR ABNORNMAL BREATH SOUNDS ó CYANOSIS ó CARDIAC DISEASE – HTN, CAD, ANGINA ó HEMOPTYSIS ó PHLEBITIS ó PULSATING ABD MASS ó ABDOMINAL PAIN ó VESICULAR PAIN WITH PALPATION ó RASH OR LESIONS ó PARADOXICAL PULSE Pericarditis: ECG: PERICARDITIS

AGGRAVATING FACTORS RELIEVING FACTORS ó BREATHING ó REST OR DECREASED MOVEMENT ó MOVEMENT ó POSITION ó STRESS ó SITTING UP OR LEANING FORWARD ó EXERTION ó DECREASED OR SHALLOW BREATHING ó AFTER EATING OR ETOH ó DIET ó LAYING DOWN ó ANTACIDS ó SITUATIONAL / ANXIETY ó MEDICATIONS PNEUMOTHORAX ONSET/DURATION OF PAIN

ó Sudden ó Gradual ó Lasts Minutes ó Lasts Hours ó Varies PNEUMOTHORAX

QUALITY LOCATION ó PLEURITIC ó SUBSTERNAL ó SPASMODIC ó CENTER OR ACROSS CHEST ó TIGHTNESS OR HEAVINESS ó LATERAL CHEST ó PRESSURE- OPPRESSIVE ó LOCALIZED OVER INVOLVED AREA ó LOWER CHEST/EPIGASTRIC ó SHARP/LOCALIZED VISCERAL/BURNING ó RADIATES TO JAW, NECK, BACK OR ARM ó TEARING / EXCRUCIATING ó VAGUE

Pneumothorax Needle Decompression PNEUMOTHORAX

HISTORY ASSOCIATED SX / SX ó AGE ó DYSPNEA ó PREVIOUS EPISODES ó DIAPHORESIS ó NAUSEA / VOMITING ó UPPER RESPIRATORY ó AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE INFECTION/FEVER ó NEURO CHANGES ó TRAUMA ó HYPO OR HYPERTENSION OR UNEQUAL BP ó STRESS ó DECREASED OR ABNORNMAL BREATH SOUNDS ó EMOTIONAL UPSET ó CYANOSIS ó HEMOPTYSIS ó CARDIAC DISEASE – HTN, CAD, ó PULSATING ABD MASS ANGINA ó ABDOMINAL PAIN ó PHLEBITIS ó VESICULAR PAIN WITH PALPATION ó RASH OR LESIONS PNEUMOTHORAX

AGGRAVATING FACTORS RELIEVING FACTORS ó BREATHING ó REST OR DECREASED MOVEMENT ó MOVEMENT ó POSITION ó STRESS ó SITTING UP OR LEANING FORWARD ó EXERTION ó DECREASED OR SHALLOW ó AFTER EATING OR ETOH BREATHING ó LAYING DOWN ó DIET ó SITUATIONAL / ANXIETY ó ANTACIDS ó MEDICATIONS PULMONARY EMBOLISM ONSET/DURATION OF PAIN

ó Sudden ó Gradual ó Lasts Minutes ó Lasts Hours ó Varies PULMONARY EMBOLISM

QUALITY LOCATION ó PLEURITIC ó SUBSTERNAL ó SPASMODIC ó CENTER OR ACROSS CHEST ó TIGHTNESS OR HEAVINESS ó LATERAL CHEST ó PRESSURE- OPPRESSIVE ó LOCALIZED OVER INVOLVED AREA ó SHARP/LOCALIZED ó LOWER CHEST/EPIGASTRIC VISCERAL/BURNING ó RADIATES TO JAW, ó TEARING / EXCRUCIATING NECK, BACK OR ARM ó VAGUE

PULMONARY EMBOLISM

HISTORY ASSOCIATED SX / SX ó AGE ó DYSPNEA ó PREVIOUS EPISODES ó DIAPHORESIS ó NAUSEA / VOMITING ó UPPER RESPIRATORY INFECTION/FEVER ó AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE ó TRAUMA ó NEURO CHANGES ó STRESS ó HYPO OR HYPERTENSION OR UNEQUAL BP ó EMOTIONAL UPSET ó DECREASED OR ABNORNMAL BREATH SOUNDS ó CYANOSIS ó CARDIAC DISEASE – HTN, CAD, ANGINA ó HEMOPTYSIS ó PHLEBITIS ó PULSATING ABD MASS ó SMOKING/RECENT SURGERY/BCP (birth ó ABDOMINAL PAIN control pill) ó VESICULAR PAIN WITH PALPATION ó RASH OR LESIONS

PE: ECG PULMONARY EMBOLISM

AGGRAVATING FACTORS RELIEVING FACTORS ó BREATHING ó REST OR DECREASED MOVEMENT ó MOVEMENT ó POSITION ó STRESS ó SITTING UP OR LEANING FORWARD ó EXERTION ó DECREASED OR SHALLOW ó AFTER EATING OR ETOH BREATHING ó LAYING DOWN ó DIET ó SITUATIONAL / ANXIETY ó ANTACIDS ó MEDICATIONS HIATAL HERNIA ONSET/DURATION OF PAIN

ó Sudden ó Gradual ó Lasts Minutes ó Lasts Hours ó Varies HIATAL HERNIA HIATAL HERNIA

QUALITY LOCATION ó PLEURITIC ó SUBSTERNAL ó SPASMODIC ó CENTER OR ACROSS CHEST ó TIGHTNESS OR HEAVINESS ó LATERAL CHEST ó PRESSURE- OPPRESSIVE ó LOCALIZED OVER INVOLVED AREA ó SHARP/LOCALIZED ó LOWER CHEST/EPIGASTRIC VISCERAL/BURNING ó RADIATES TO JAW, ó TEARING / EXCRUCIATING NECK, BACK OR ARM ó VAGUE HIATAL HERNIA

HISTORY ASSOCIATED SX / SX ó AGE ó DYSPNEA ó PREVIOUS EPISODES ó DIAPHORESIS ó NAUSEA / VOMITING ó UPPER RESPIRATORY ó AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE INFECTION/FEVER ó NEURO CHANGES ó TRAUMA ó HYPO OR HYPERTENSION OR UNEQUAL BP ó STRESS ó DECREASED OR ABNORMAL BREATH SOUNDS ó EMOTIONAL UPSET ó CYANOSIS ó HEMOPTYSIS ó CARDIAC DISEASE – HTN, CAD, ó PULSATING ABD MASS ANGINA ó ABDOMINAL PAIN ó PHLEBITIS ó VESICULAR PAIN WITH PALPATION ó RASH OR LESIONS HIATAL HERNIA

AGGRAVATING FACTORS RELIEVING FACTORS ó BREATHING ó REST OR DECREASED MOVEMENT ó MOVEMENT ó POSITION ó STRESS ó SITTING UP OR LEANING FORWARD ó EXERTION ó DECREASED OR SHALLOW ó AFTER EATING OR ETOH BREATHING ó LAYING DOWN ó DIET ó SITUATIONAL / ANXIETY ó ANTACIDS ó MEDICATIONS GASTROINTESTINAL ONSET/DURATION OF PAIN

ó Sudden ó Gradual ó Lasts Minutes ó Lasts Hours ó Varies GASTROINTESTINAL

QUALITY LOCATION ó PLEURITIC ó SUBSTERNAL ó SPASMODIC ó CENTER OR ACROSS CHEST ó TIGHTNESS OR HEAVINESS ó LATERAL CHEST ó PRESSURE- OPPRESSIVE ó LOCALIZED OVER INVOLVED AREA ó SHARP/ LOCALIZED ó LOWER CHEST/EPIGASTRIC VISCERAL/ BURNING ó RADIATES TO JAW, ó TEARING / EXCRUCIATING NECK, BACK OR ARM ó VAGUE GASTROINTESTINAL

HISTORY ASSOCIATED SX / SX ó AGE ó DYSPNEA ó PREVIOUS EPISODES ó DIAPHORESIS ó NAUSEA / VOMITING ó UPPER RESPIRATORY ó AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE INFECTION/FEVER ó NEURO CHANGES ó TRAUMA ó HYPO OR HYPERTENSION OR UNEQUAL BP ó STRESS ó DECREASED OR ABNORNMAL BREATH SOUNDS ó EMOTIONAL UPSET ó CYANOSIS ó HEMOPTYSIS ó CARDIAC DISEASE – HTN, CAD, ó PULSATING ABD MASS ANGINA ó ABDOMINAL PAIN Maybe none…. For example, food ó PHLEBITIS poisoning doesn’t require a history ó VESICULAR PAIN WITH PALPATION other than recent eating. ó RASH OR LESIONS GASTROINTESTINAL

AGGRAVATING FACTORS RELIEVING FACTORS ó BREATHING ó REST OR DECREASED MOVEMENT ó MOVEMENT ó POSITION ó STRESS ó SITTING UP OR LEANING FORWARD ó EXERTION ó DECREASED OR SHALLOW ó AFTER EATING OR ETOH BREATHING ó LAYING DOWN ó DIET ó SITUATIONAL / ANXIETY ó ANTACIDS ó MEDICATIONS PNEUMONIA/PLEURISY ONSET/DURATION OF PAIN

ó Sudden ó Gradual ó Lasts Minutes ó Lasts Hours ó Varies PNEUMONIA/PLEURISY

QUALITY LOCATION ó PLEURITIC ó SUBSTERNAL ó SPASMODIC ó CENTER OR ACROSS CHEST ó TIGHTNESS OR HEAVINESS ó LATERAL CHEST ó PRESSURE- OPPRESSIVE ó LOCALIZED OVER INVOLVED AREA ó SHARP/LOCALIZED ó LOWER CHEST/EPIGASTRIC VISCERAL/BURNING ó RADIATES TO JAW, ó TEARING / EXCRUCIATING NECK, BACK OR ARM ó VAGUE PNEUMONIA/PLEURISY

HISTORY ASSOCIATED SX / SX ó AGE ó DYSPNEA ó PREVIOUS EPISODES ó DIAPHORESIS ó NAUSEA / VOMITING ó UPPER RESPIRATORY ó AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE INFECTION/FEVER ó NEURO CHANGES ó TRAUMA ó HYPO OR HYPERTENSION OR UNEQUAL BP ó STRESS ó DECREASED OR ABNORNMAL BREATH SOUNDS ó EMOTIONAL UPSET ó CYANOSIS ó HEMOPTYSIS ó CARDIAC DISEASE – HTN, CAD, ó PULSATING ABD MASS ANGINA ó ABDOMINAL PAIN ó PHLEBITIS ó VESICULAR PAIN WITH PALPATION ó RASH OR LESIONS PNEUMONIA/PLEURISY

AGGRAVATING FACTORS RELIEVING FACTORS ó BREATHING ó REST OR DECREASED MOVEMENT ó MOVEMENT ó POSITION ó STRESS ó SITTING UP OR LEANING FORWARD ó EXERTION ó DECREASED OR SHALLOW ó AFTER EATING OR ETOH BREATHING ó LAYING DOWN ó DIET ó SITUATIONAL / ANXIETY ó ANTACIDS ó MEDICATIONS HYPERVENTILATION/ANXIETY ONSET/DURATION OF PAIN

ó Sudden ó Gradual ó Lasts Minutes ó Lasts Hours ó Varies HYPERVENTILATION/ANXIETY

QUALITY LOCATION ó PLEURITIC ó SUBSTERNAL ó SPASMODIC ó CENTER OR ACROSS CHEST ó TIGHTNESS OR HEAVINESS ó LATERAL CHEST ó PRESSURE- OPPRESSIVE ó LOCALIZED OVER INVOLVED AREA ó SHARP/LOCALIZED ó LOWER CHEST/EPIGASTRIC VISCERAL/BURNING ó RADIATES TO JAW, ó TEARING / EXCRUCIATING NECK, BACK OR ARM ó VAGUE/DIFFUSE ó VAGUE HYPERVENTILATION/ANXIETY

HISTORY ASSOCIATED SX / SX ó AGE ó DYSPNEA ó PREVIOUS EPISODES ó DIAPHORESIS ó NAUSEA / VOMITING ó UPPER RESPIRATORY ó AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE INFECTION/FEVER ó NEURO CHANGES ó TRAUMA ó HYPO OR HYPERTENSION OR UNEQUAL BP ó STRESS ó DECREASED OR ABNORNMAL BREATH SOUNDS ó EMOTIONAL UPSET ó CYANOSIS ó HEMOPTYSIS ó CARDIAC DISEASE – HTN, CAD, ó PULSATING ABD MASS ANGINA ó ABDOMINAL PAIN ó PHLEBITIS ó VESICULAR PAIN WITH PALPATION ó RASH OR LESIONS ó INCREASED RESP RATE ó NUMBNESS –EXTREMITIES/FACE HYPERVENTILATION/ANXIETY

AGGRAVATING FACTORS RELIEVING FACTORS ó BREATHING ó REST OR DECREASED MOVEMENT ó MOVEMENT ó POSITION ó STRESS ó SITTING UP OR LEANING FORWARD ó EXERTION ó DECREASED OR SHALLOW ó AFTER EATING OR ETOH BREATHING ó LAYING DOWN ó DIET ó SITUATIONAL / ANXIETY ó ANTACIDS ó MEDICATIONS ó DECREASED ANXIETY Hyperventilation Syndrome ó Causes can be: ó Organic – CNS lesions, meningitis, drug ingestion ó Physiologic – response to heat, exercise, altitude acclimation ó Emotional – anxiety, anger, fear, depression ó Chronic – sympathetic nervous system stimulation Hyperventilation Syndrome ó Causes ó ó Anxiety Neurological disorders ó ó Hypoxia Fever ó ó Pulmonary disease Infection ó ó Cardiovascular Pain disorders ó Pregnancy ó Metabolic disorders ó Drug use ó hyperglycemia, acidosis ó aspirin

} Hyperventilation caused by emotions (psychogenic dyspnea) is a diagnosis of exclusion!

68 Resource: Laurie Carroll, RN, Advocate Bolingbrook Hospital