Case ScenarioCentral Chest Pain Evaluation

for undergraduates and post graduates

Central Chest Pain EvaluationDr. Md.Toufiqur

Rahman MBBS, FCPS, MD, FACC, FESC, FRCP, FSCAI,

FAPSC, FAPSIC, FAHAAssociate Professor of Cardiology

National Institute of Cardiovascular DiseasesSher-e-Bangla Nagar, Dhaka-1207

Consultant, Medinova, Malbagh branch.Honorary Consultant, Apollo Hospitals, Dhaka and

Life Care Centre, Dhanmondidrtoufiq19711@yahoo.com

Case Scenario----1A 65 years old hypertensive, smoker, diabetic and

dyslipidemic gentleman from Mymensingh district presented with central chest tightness on exertion for last 1 months. His pulse was 104 b/min, BP-150/95 mm Hg, HbA1c-8.2%. His ECG was normal . What should be his next investigation? What was the probable cause of his chest tightness?

a. Esophageal spasm b. Chronic stable angina c. acute coronary syndrome d. acute pericarditis

Case Scenario----2A 55 years old hypertensive, smoker, diabetic and

dyslipidemic gentleman from Dhanmondi presented with central chest tightness with excessive sweating for last 30 minutes not relieved by taking sublingual nitrates. His pulse was 104 b/min, BP-150/95 mm Hg, HbA1c-8.2%. His ECG showed ST segment elevation in V1-V5 . What was the probable cause of his chest tightness?

a. Esophageal spasm b. Chronic stable angina c. acute coronary syndrome(STEMI) d. acute pericarditis

Case Scenario----3A 55 years old hypertensive, smoker, diabetic and

dyslipidemic gentleman from Tejgaon presented with central chest tightness with excessive sweating for last 30 minutes not relieved by taking sublingual nitrates. His pulse was 104 b/min, BP-150/95 mm Hg, HbA1c-8.2%. His ECG showed ST segment depression in V1-V5 . His Troponin I level is 30 ng/L. What was the probable cause of his chest tightness?

a. Esophageal spasm b. Chronic stable angina c. acute coronary syndrome(NSTEMI) d. acute pericarditis

Case Scenario----4A 52 years old hypertensive, smoker, diabetic and

dyslipidemic gentleman from Bashaboo presented with central chest tightness with excessive sweating for last 20 minutes not relieved by taking sublingual nitrates. His pulse was 110 b/min, BP-140/95 mm Hg, HbA1c-9.2%. His ECG showed T inversion in V1-V4 . His Troponin I level is normal. What was the probable cause of his chest tightness?

a. Esophageal spasm b. Chronic stable angina c. acute coronary syndrome(Unstable angina) d. acute pericarditis

Case Scenario----5A 32 years old smoker gentleman from Naogaon

presented with central chest pain for last 5 days with fever. His pulse was 120 b/min, BP-140/95 mm Hg. His ECG showed ST segment elevation in lead V1-V6 and lead 2, 3 and aVF . What was the probable cause of his chest pain ?

a. Esophageal spasm b. Chronic stable angina c. acute coronary syndrome d. acute pericarditis

Case Scenario----6A 42 years old smoker gentleman from Rajshahi

presented with central chest pain for last 35 days increased at night lying flat relieved by taking antacid syrup. His pulse was 80 b/min, BP-130/85 mm Hg. His ECG showed normal. What was the probable cause of his chest pain?

a. Reflux esophagitis b. Chronic stable angina c. acute coronary syndrome d. acute pericarditis

Case Scenario----7A 22 years old lady from Khulna district

presented with central chest pain with palpitations for last 5 months. Her pulse was 110 b/min, BP-120/80 mm Hg. Her ECG showed normal , Echocardiography showed normal study, ETT done previously for 2 times were negative. What was the probable cause of his chest pain?

a. Reflux esophagitis b. Chronic stable angina c. acute coronary syndrome d. Generalized Anxiety Disorder

Case Scenario----8A 25 years old lady from Kustia district presented

with central chest heaviness with palpitations with low grade fever for last 2 months. Her pulse was 110 b/min, BP-110/70 mm Hg. Her ECG showed low voltage , Echocardiography showed echo free space in pericardium. What was the probable cause of his chest pain?

a. Reflux esophagitis b. Chronic stable angina c. Pericardial Effussion d. Generalized Anxiety Disorder

Case Scenario----9A 25 years old lady from Kustia district presented

with central chest heaviness with palpitations with low grade fever for last 2 months. Her pulse was 110 b/min, BP-110/70 mm Hg. Her ECG showed low voltage , Echocardiography showed echo free space in pericardium. What was the probable cause of his chest pain?

a. Reflux esophagitis b. Chronic stable angina c. Pericardial Effussion d. Generalized Anxiety Disorder

Case Scenario----10A 19 years old smoker gentleman from Panchagor

presented with central chest pain for last 5 days with fever and shortness of breath. His pulse was 120 b/min, BP-110/75 mm Hg. His ECG showed T inversion in lead V1-V6 . His echocardiography showed global hypokinesia with EF-40%, Troponin I positive. What was the probable cause of his chest pain ?

a. Myocarditis b. Chronic stable angina c. acute coronary syndrome d. acute pericarditis

Case Scenario----11A 27 years old gentleman from Chuadanga district

presented with occasional chest pain with palpitations for last 2 years. His pulse was 110 b/min, BP-110/70 mm Hg. His ECG showed normal , Echocardiography showed echo mitral valvular disease. What was the probable cause of his chest pain?

a. Mitral valve prolapse b. Chronic stable angina c. Pericardial Effusion d. Generalized Anxiety Disorder

Case Scenario----12A 21 years old gentleman from Sathkhira district

presented with occasional central chest pain with palpitations for last 3 years. He was diagnosed as a case of Marfans Syndrome. His pulse was 112 b/min, BP-110/70 mm Hg. His ECG showed normal , Echocardiography showed echo aortic root dilataion. What was the probable cause of his chest pain?

a. Mitral valve prolapse b. Chronic stable angina c. Pericardial Effusion d. Aortic Aneurysm

Case Scenario----13A 50 years old hypertensive, smoker, diabetic and

dyslipidemic gentleman from Jatrabari presented with severe tearing central chest pain with excessive sweating for last 30 minutes not relieved by taking sublingual nitrates. His pulse was 104 b/min, no pulse in lower limbs BP-150/95 mm Hg, HbA1c-8.2%. His ECG showed left ventricular hypertrophy . What was the probable cause of his chest tightness?

a. Esophageal spasm b. aortic dissection c. acute coronary syndrome(STEMI) d. acute pericarditis

Case Scenario----14A 70 years old hypertensive, smoker, diabetic and

dyslipidemic gentleman from Jessore presented with central chest pain with burning sensation in mouth while taking food. His pulse was 86 b/min, BP-140/95 mm Hg, HbA1c-8.2%. Oral examination showed oral thrush. His ECG showed left ventricular hypertrophy . What was the probable cause of his chest tightness?

a. Esophagitis ( Fungal infection) b. aortic dissection c. acute coronary syndrome(STEMI) d. acute pericarditis

Thank you all