![]() ![]() AP had a terrible night’s sleep as the pain seemed to intensify when he lay flat in bed, so he slept mostly sitting upright in a chair. His breathing feels restricted because of the pain, but he is not overtly short of breath. Serious cardiovascular conditions, including myocardial infarction, unstable angina, pulmonary embolism and heart failureĪP reports a pleuretic, sharp pain that is localised to his left thorax without any radiation. Causes of chest pains presenting in general practice, compared with emergency departments 1 Common causes of chest pain are shown in Table 1. acute changes in vital signs, with particular attention to signs of shock (ie diaphoresis, clamminess, tachycardia, decreased blood pressure)Īs with the history taking, respiratory, abdominal and localised musculoskeletal examinations are also likely to be indicated.Blood pressure should be measured in both arms and the patient assessed for presence of: Physical examination of a patient who presents with chest pain includes primarily a cardiovascular examination. The cardiovascular system is the main focus in patients who present with chest pain, but evaluation of the respiratory system, upper gastrointestinal system and focused musculoskeletal history, looking specifically for trauma in the area of pain, is also required. After elaborating on the presenting complaint, the history should focus on the presence of risk factors, such as history of cardiovascular disease, connective tissue or autoimmune diseases, renal impairment, diabetes, hypertension, dyslipidaemia, positive family history of cardiac disease and smoking history. Important elements on history are the description of the pain and its associated symptoms. History takingĬhest pain is a common presenting symptom and the initial clinical assessment is vital in differentiating and triaging the direction of care. ![]() These two methods are complementary and should ideally be associated in the same device.AP is a male, aged 20 years, who presents to your practice with chest pains that commenced the preceding night, now exceeding 12 hours in duration. ![]() ![]() The main disadvantages are (1) some oscillometric curves are difficult to read accurately (2) oscillometry is very sensitive to movements due to the bandwidth of the signals, so the arm must be immobile and (3) the accuracy of the systolic and diastolic BP depends on the algorithm used. The main advantages are (1) possibility of BP measurement when the Korotkoff signal is poor (2) measurement of the mean arterial BP and (3) no need of a microphonic sensor. The systolic and diastolic BP are determined by an algorithmic interpretation of the shape of oscillometric amplitudes as well as the heart rate. The maximum oscillation is related to the mean arterial pressure. With the oscillometric method, air volume variations in the cuff are detected during deflation. This may allow relatively accurate BP measurement during mild exercise. Difficulties can be overcome by appropriate signal processing (K2 recognition), noise rejection and/or ECG gating. The main disadvantages of this method are (1) artefacts due to movements and (2) difficulties in signal analysis due to physiological variations of the Korotkoff sound patterns or poor signals. Its main advantages are (1) similarities with usual clinical measurement of BP and (2) accurate detection of systolic and diastolic pressures on the appearance and disappearance of sounds. The auscultatory method is based on the detection of Korotkoff sounds issued from the acoustic transudcer signal. Two methods of indirect blood pressure (BP) measurement are currently used for ambulatory blood pressure measurement (ABPM): the auscultatory and oscillometric methods. ![]()
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