• Contents :

Differential Diagnoses by Symptomatology (tbw)

🫀 Acute Coronary Syndrome

Angina—Cardiac Chest Pain

Typical angina requires all criteria of

• [ ] retrosternal pain which might radiate to upper extremity/mandible/jaw uni/bilaterally (usually lasts the same duration ~5 minutes)
• [ ] pain is provoked and worsened by exertion (or emotional stress)
• [ ] pain is alleviated by rest or sublingual ISDN

—similar typical anginas (mostly predictable) = stable angina = Chronic Coronary Syndrome

Atypical angina is any angina that does not meet all criteria for the typical type.

🌜Crescendo is the worsening character of anginal pain, reflecting instability.

Myocardial infarction is defined by the typical rise and fall of cardiac biomarkers with

• ischemic symptoms (= angina)
• new pathological Q wave
• ECG changes indicative of infarction
• prior coronary intervention

Algorithm of Differential Diagnosis :

Clinical → Initial management / Investigation → Diagnosis → Treatment

1. Detect cardiac chest pain (especially some atypical presentations e.g. dyspepsia-mimic, epigastric pain, mandibular pain)

2. Initial managements (ACS Orders) :

• ECG with defibrillator patch
• Blood for hs-cTn at 0-1 for R/O, 0-3 for R/I
• Keep room air SpO₂ ≥ 90%

Electrocardiography