Chest Pain: A Clinical Assessment

Diagnostic Evaluation of Nontraumatic Chest Pain in Athletes

This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes. Cross-referencing published articles from the databases searched discovered additional articles. No dissertations, theses, or meeting proceedings were reviewed. The authors discuss the scope of this complex problem and the diagnostic dilemma chest pain in athletes can provide. Next, the authors delve into the vast differential and attempt to simplify this process for the sports medicine physician by dividing potential etiologies into cardiac and noncardiac conditions. Life-threatening causes of chest pain in athletes may be cardiac or noncardiac in origin, which highlights the need for the sports medicine physician to consider pathology in multiple organ systems simultaneously. This article emphasizes the importance of ruling out immediately life threatening diagnoses, while acknowledging the most common causes of noncardiac chest pain in young athletes are benign. The authors propose a practical algorithm the sports medicine physician can use as a guide for the assessment and diagnostic work-up of the athlete with chest pain designed to help the physician arrive at the correct diagnosis in a clinically efficient and cost-effective manner.

Chest pain after kidney transplantation owing to pneumomediastinum: a case report

BACKGROUND

Chest pain in kidney transplant recipients can signify a life-threatening condition.

CASE REPORT

A patient with polycystic kidney disease who underwent living donor kidney transplantation with open bilateral native nephrectomy developed acute substernal chest pain 10 days post-transplantation. History, physical, and diagnostic studies identified no cardiac or pulmonary causes for the pain, but radiography showed mediastinal air. No vascular or thoracic injury explained the development of the pneumomediastinum. After 1 day on oxygen, the chest pain symptoms resolved. Repeat x-rays showed resolution of the pneumomediastinum.

DISCUSSION

Pneumomediastinum resulting from air migrating from the abdominal cavity to the thorax has not been described after open removal of diseased abdominal organs. This case illustrates that creation of a potential space in the abdominal cavity can be associated with the development of pneumomediastinum.

CONCLUSIONS

Conservative measures were sufficient to resolve the pneumomediastinum and symptoms in this patient.

Medical Domain Knowledge and Associative Classification Rules in Diagnosis

Hospital information systems have been frustrated by problems that include congestion, long wait time, and delayed patient care over decades. To solve these problems, data mining techniques have been used in medical research for many years and are known to be effective. Therefore, this study examines building a hybrid data mining methodology, combining medical domain knowledge and associative classification rules. Real world emergency data are collected from a hospital and the methodology is evaluated by comparing it with other techniques. The methodology is expected to help physicians to make rapid and accurate diagnosis of chest diseases.

An algorithm for the diagnosis and management of chest pain in primary care

This article focuses on the key clinical and investigatory features that help differentiate the multiple causes of chest pain in adults in assessment of patients with undifferentiated chest pain in primary care using history, physical examination, and basic initial investigations. The initial treatment of many of the causes is discussed. Some treatments not only relieve symptoms but also provide further diagnostic information based on the response to treatment. Guidance for referral for specialist assessment and further investigations is provided, but the diagnostic usefulness of these measures is not discussed.

Circumferential Involvement of an Acute Type B Aortic Dissection: A Unique Case

A case of a 35-year-old woman with acute circumferential type B aortic dissection is presented. A review of the literature demonstrated that circumferential aortic dissection is limited to a small number of case reports and a small case series of type A lesions. This is the first report of a circumferential type B dissection. The case highlights the need to fully evaluate patients with acute aortic dissection and illustrates the unique data provided by transesophageal echocardiography and helical computed tomographic angiography.