Uterovaginal Prolapse Is a form of Hernia in which the uterus and Vagina protrudes down out of their normal confinement.
Types
I. Vaginal
a. Anterior wall
-Cystocele( Uriary bladder prolapse)
-Urethrocele( Urethra)
-Combined
b.Posterior wall
-Relaxed perinium
-Rectocele
-Vault prolapse
II. Uterine
Uterovaginal
Congenital
Causes Of Prolapse
Preciptating factors
I. Acquired
a. Overstretching of mackenrodth and Uterosacral Ligaments due to
Premature bear down
Application of forceps when cervix not fully dilated
down pressure on fundus to deliver placents
Precipitate labour
b. Overstretching of endopelvic fascial sheath of vagina
Degree of distension during delivery and duration
c.Subinvolution
ill nourished mother
early resumption of work
perisitent overfilling of bladder
repeated childbirth
d.Over stretching of perinium
Congenital
Spina Bifida occulta
Neurological disorders.
II. Aggravating factors.
a Increased abd pressure.
cough, constipation
b. bulky uterus, fibroid.
c.post menopausal atrophy
d.Asthenia and undernutrition
Overstretchin of perinium
Rhinophyma: Cosmetic Issue
Rhinophyma
Rhinophyma (an advanced type of rosacea) is characterized by an enlarged, bulbous, and red nose resulting from enlargement of the oil-producing glands beneath the surface of the skin on the nose. Depending on the severity of rhinophyma, doctors may begin treatment with topical or oral rosacea treatment.
What Is Rhinophyma?
To understand what rhinophyma is, it's important to first have a basic understanding of rosacea. Rosacea is a chronic disease that affects the skin. The disease is characterized by redness, pimples, and, in advanced stages, thickened skin. When rosacea reaches this advanced stage, rhinophyma may develop. The most common characteristic of rhinophyma is an enlarged, bulbous, and red nose. Rhinophyma is associated with the sebaceous (oil-producing) glands beneath the surface of the skin on the nose. The condition is more common in men than women.
Symptoms of Rhinophyma
Rhinophyma is characterized by an enlarged, bulbous, and red nose resulting from the enlargement of the sebaceous (oil-producing) glands beneath the surface of the skin on the nose.
What Causes Rhinophyma?
Doctors do not know the exact cause of rhinophyma.
Diagnosing Rhinophyma
Dermatologists usually diagnose rhinophyma by its appearance and associated symptoms because there are no tests that can diagnose this disease. However, on rare occasions, skin biopsies can pinpoint rhinophyma. Doctors will usually diagnose a patient with rhinophyma if the patient has rhinophyma symptoms and a family history of rhinophyma.
Current Treatment of Rhinophyma
Depending on the severity of the rhinophyma, doctors may begin treatment with topical or oral rosacea medications. Rhinophyma that does not respond to medications may be treated with:
Electrosurgery
Laser treatment
Dermabrasion
Resculpturing
Rhinophyma (an advanced type of rosacea) is characterized by an enlarged, bulbous, and red nose resulting from enlargement of the oil-producing glands beneath the surface of the skin on the nose. Depending on the severity of rhinophyma, doctors may begin treatment with topical or oral rosacea treatment.
What Is Rhinophyma?
To understand what rhinophyma is, it's important to first have a basic understanding of rosacea. Rosacea is a chronic disease that affects the skin. The disease is characterized by redness, pimples, and, in advanced stages, thickened skin. When rosacea reaches this advanced stage, rhinophyma may develop. The most common characteristic of rhinophyma is an enlarged, bulbous, and red nose. Rhinophyma is associated with the sebaceous (oil-producing) glands beneath the surface of the skin on the nose. The condition is more common in men than women.
Symptoms of Rhinophyma
Rhinophyma is characterized by an enlarged, bulbous, and red nose resulting from the enlargement of the sebaceous (oil-producing) glands beneath the surface of the skin on the nose.
What Causes Rhinophyma?
Doctors do not know the exact cause of rhinophyma.
Diagnosing Rhinophyma
Dermatologists usually diagnose rhinophyma by its appearance and associated symptoms because there are no tests that can diagnose this disease. However, on rare occasions, skin biopsies can pinpoint rhinophyma. Doctors will usually diagnose a patient with rhinophyma if the patient has rhinophyma symptoms and a family history of rhinophyma.
Current Treatment of Rhinophyma
Depending on the severity of the rhinophyma, doctors may begin treatment with topical or oral rosacea medications. Rhinophyma that does not respond to medications may be treated with:
Electrosurgery
Laser treatment
Dermabrasion
Resculpturing
ALOPECIA: HAIR LOSS causes
Hair loss
loss of hair is called alopecia.
Facts:
Hair loss usually develops gradually and may be patchy or diffuse (all over).
Hair loss usually develops gradually and may be patchy or diffuse (all over).
Roughly 100 hairs are lost from your head every day.
The average scalp contains about 100,000 hairs.
Each individual hair survives for an average of 4-1/2 years, during which time it grows about half an inch a month. Usually in its 5th year, the hair falls out and is replaced within 6 months by a new one.
Each individual hair survives for an average of 4-1/2 years, during which time it grows about half an inch a month. Usually in its 5th year, the hair falls out and is replaced within 6 months by a new one.
Genetic baldness is caused by the body's failure to produce new hairs and not by excessive hair loss.
Both men and women tend to lose hair thickness and amount as they age. Inherited or "pattern baldness" affects many more men than women. About 25% of men begin to bald by the time they are 30 years old, and about two-thirds are either bald or have a balding pattern by age 60.
Both men and women tend to lose hair thickness and amount as they age. Inherited or "pattern baldness" affects many more men than women. About 25% of men begin to bald by the time they are 30 years old, and about two-thirds are either bald or have a balding pattern by age 60.
male pattern baldness involves a receding hairline and thinning around the crown with eventual bald spots. Ultimately, you may have only a horseshoe ring of hair around the sides. In addition to genes, male-pattern baldness seems to require the presence of the male hormone testosterone . Men who do not produce testosterone (because of genetic abnormalities or castration) do not develop this pattern of baldness.
Some women also develop a particular pattern of hair loss due to genetics, age, and male hormones that tend to increase in women after menopause. The pattern is different from that of men. Female pattern baldness involves a thinning throughout the scalp while the frontal hairline generally remains intact.
Common Causes:
Baldness is not usually caused by a disease, but is related to aging, heredity, and testosterone. In addition to the common male and female patterns from a combination of these factors, other possible causes of hair loss, especially if in an unusual pattern, include:
Alopecia areata -- bald patches that develop on the scalp, beard, and, possibly, eyebrows. Eyelashes may fall out as well.
Autoimmune conditions such as lupus
Burns
Certain infectious diseases such as syphilis
Chemotherapy
Emotional or physical stress
Excessive shampooing and blow-drying
Fever
Hormonal changes -- for example, thyroid disease , childbirth, or use of birth control pills
Nervous habits such as continual hair pulling or scalp rubbing
Radiation therapy
Tinea capitis (ringworm of the scalp)
Tumor of the ovary or adrenal glands
Baldness is not usually caused by a disease, but is related to aging, heredity, and testosterone. In addition to the common male and female patterns from a combination of these factors, other possible causes of hair loss, especially if in an unusual pattern, include:
Alopecia areata -- bald patches that develop on the scalp, beard, and, possibly, eyebrows. Eyelashes may fall out as well.
Autoimmune conditions such as lupus
Burns
Certain infectious diseases such as syphilis
Chemotherapy
Emotional or physical stress
Excessive shampooing and blow-drying
Fever
Hormonal changes -- for example, thyroid disease , childbirth, or use of birth control pills
Nervous habits such as continual hair pulling or scalp rubbing
Radiation therapy
Tinea capitis (ringworm of the scalp)
Tumor of the ovary or adrenal glands
The Largest Physics experiment : Hoax of Doomsday ??
- When u attack the most difficult and fundamental questions [in science] you get a wide range of innovations, from MRI scanners to Facebook
"f you destroy particle physics and astronomy you will not produce more scientists working on carbon capture, you will just produce fewer scientists. "
Professor David L Wark
"The most powerful physics experiment ever built, the Large Hadron Collider will re-create the conditions just after the Big Bang in an attempt to answer fundamental questions of science and the universe itself. "
For More http://news.bbc.co.uk/2/hi/science/nature/7567926.stm
10 September,
News of Suicide by a Girl in India:
The Fear of Doomsday, Hoax made by Indian Cheap News Channels Like AAjtak, has lead to suicide of a Girl in Bhopal.
Since last 7-8 days the channels have been making a hoax of a doomsday resulting from this experiment, creating fear in the minds of the viewers. even my friends got scared... like these were the last few days to live...
Is it right to make such kinda publicites just to increase TPR of TV channels.?
Please leave you valuable coments>>>>
Top Medical sites 2008
1 WebMD.com
6,742,178 - Inbound Links 11,264,170 - Compete Monthly Visitors 12,000,000 - Quantcast Monthly Visitors 1,653 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
2 NIH.gov
11,433,993 - Inbound Links 7,557,134 - Compete Monthly Visitors 9,000,000 - Quantcast Monthly Visitors 363 - Alexa Ranking. Page Rank: 9Top 20 Health Websites Posted 08/19/2008 eBizMBA
3 MayoClinic.com
409,085 - Inbound Links 3,751,224 - Compete Monthly Visitors 5,100,000 - Quantcast Monthly Visitors 3,792 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
4 MedicineNet.com
1,301,253 - Inbound Links 3,653,861 - Compete Monthly Visitors 4,600,000 - Quantcast Monthly Visitors 3,240 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
5 everydayHealth.com
12,535 - Inbound Links 4,771,021 - Compete Monthly Visitors 3,400,000 - Quantcast Monthly Visitors 12,764 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
6 Healthline.com
79,366 - Inbound Links 2,184,783 - Compete Monthly Visitors 3,000,000 - Quantcast Monthly Visitors 6,792 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
7 RevolutionHealth.com
765,016 - Inbound Links 2,103,307 - Compete Monthly Visitors 2,900,000 - Quantcast Monthly Visitors 13,344 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
8 Drugs.com
828,653 - Inbound Links 1,945,465 - Compete Monthly Visitors 2,300,000 - Quantcast Monthly Visitors 6,287 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
9 MedHelp.org
99,673 - Inbound Links 1,578,331 - Compete Monthly Visitors 2,000,000 - Quantcast Monthly Visitors 8,042 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
10 RxList.com
1,171,219 - Inbound Links 1,525,818 - Compete Monthly Visitors 2,000,000 - Quantcast Monthly Visitors 11,657 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
11 eMedicine.com
1,157,159 - Inbound Links 1,233,573 - Compete Monthly Visitors 1,500,000 - Quantcast Monthly Visitors 5,835 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
12 RealAge.com
41,051 - Inbound Links 1,577,068 - Compete Monthly Visitors 1,700,000 - Quantcast Monthly Visitors 8,852 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
13 QualityHealth.com
64,299 - Inbound Links 1,201,368 - Compete Monthly Visitors 1,500,000 - Quantcast Monthly Visitors 28,221 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
14 eDiets.com
136,820 - Inbound Links 1,238,852 - Compete Monthly Visitors 1,400,000 - Quantcast Monthly Visitors 8,239 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
15 familydoctor.org
474,004 - Inbound Links 856,565 - Compete Monthly Visitors 1,100,000 - Quantcast Monthly Visitors 12,655 - Alexa Ranking. Page Rank: NATop 20 Health Websites Posted 08/19/2008 eBizMBA
16 diet.com
119,873 - Inbound Links 1,160,260 - Compete Monthly Visitors 328,084 - Quantcast Monthly Visitors 10,629 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
17 Prevention.com
116,542 - Inbound Links 853,420 - Compete Monthly Visitors 685,947 - Quantcast Monthly Visitors 20,991 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
18 Healthology.com
2,774,943 - Inbound Links 580,139 - Compete Monthly Visitors 355,631 - Quantcast Monthly Visitors 32,541 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
19 MensHealth.com
180,139 - Inbound Links 439,530 - Compete Monthly Visitors 381,350 - Quantcast Monthly Visitors 7,744 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
20 WHO.int
1,848,622 - Inbound Links 205,802 - Compete Monthly Visitors NA - Quantcast Monthly Visitors 4,236 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
6,742,178 - Inbound Links 11,264,170 - Compete Monthly Visitors 12,000,000 - Quantcast Monthly Visitors 1,653 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
2 NIH.gov
11,433,993 - Inbound Links 7,557,134 - Compete Monthly Visitors 9,000,000 - Quantcast Monthly Visitors 363 - Alexa Ranking. Page Rank: 9Top 20 Health Websites Posted 08/19/2008 eBizMBA
3 MayoClinic.com
409,085 - Inbound Links 3,751,224 - Compete Monthly Visitors 5,100,000 - Quantcast Monthly Visitors 3,792 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
4 MedicineNet.com
1,301,253 - Inbound Links 3,653,861 - Compete Monthly Visitors 4,600,000 - Quantcast Monthly Visitors 3,240 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
5 everydayHealth.com
12,535 - Inbound Links 4,771,021 - Compete Monthly Visitors 3,400,000 - Quantcast Monthly Visitors 12,764 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
6 Healthline.com
79,366 - Inbound Links 2,184,783 - Compete Monthly Visitors 3,000,000 - Quantcast Monthly Visitors 6,792 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
7 RevolutionHealth.com
765,016 - Inbound Links 2,103,307 - Compete Monthly Visitors 2,900,000 - Quantcast Monthly Visitors 13,344 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
8 Drugs.com
828,653 - Inbound Links 1,945,465 - Compete Monthly Visitors 2,300,000 - Quantcast Monthly Visitors 6,287 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
9 MedHelp.org
99,673 - Inbound Links 1,578,331 - Compete Monthly Visitors 2,000,000 - Quantcast Monthly Visitors 8,042 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
10 RxList.com
1,171,219 - Inbound Links 1,525,818 - Compete Monthly Visitors 2,000,000 - Quantcast Monthly Visitors 11,657 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
11 eMedicine.com
1,157,159 - Inbound Links 1,233,573 - Compete Monthly Visitors 1,500,000 - Quantcast Monthly Visitors 5,835 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
12 RealAge.com
41,051 - Inbound Links 1,577,068 - Compete Monthly Visitors 1,700,000 - Quantcast Monthly Visitors 8,852 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
13 QualityHealth.com
64,299 - Inbound Links 1,201,368 - Compete Monthly Visitors 1,500,000 - Quantcast Monthly Visitors 28,221 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
14 eDiets.com
136,820 - Inbound Links 1,238,852 - Compete Monthly Visitors 1,400,000 - Quantcast Monthly Visitors 8,239 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
15 familydoctor.org
474,004 - Inbound Links 856,565 - Compete Monthly Visitors 1,100,000 - Quantcast Monthly Visitors 12,655 - Alexa Ranking. Page Rank: NATop 20 Health Websites Posted 08/19/2008 eBizMBA
16 diet.com
119,873 - Inbound Links 1,160,260 - Compete Monthly Visitors 328,084 - Quantcast Monthly Visitors 10,629 - Alexa Ranking. Page Rank: 5Top 20 Health Websites Posted 08/19/2008 eBizMBA
17 Prevention.com
116,542 - Inbound Links 853,420 - Compete Monthly Visitors 685,947 - Quantcast Monthly Visitors 20,991 - Alexa Ranking. Page Rank: 6Top 20 Health Websites Posted 08/19/2008 eBizMBA
18 Healthology.com
2,774,943 - Inbound Links 580,139 - Compete Monthly Visitors 355,631 - Quantcast Monthly Visitors 32,541 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
19 MensHealth.com
180,139 - Inbound Links 439,530 - Compete Monthly Visitors 381,350 - Quantcast Monthly Visitors 7,744 - Alexa Ranking. Page Rank: 7Top 20 Health Websites Posted 08/19/2008 eBizMBA
20 WHO.int
1,848,622 - Inbound Links 205,802 - Compete Monthly Visitors NA - Quantcast Monthly Visitors 4,236 - Alexa Ranking. Page Rank: 8Top 20 Health Websites Posted 08/19/2008 eBizMBA
Chest Pain Differential Diagnosis
Myocardial Ischaemic Pain
The main feature of myocardial ischaemia (impending infarction) is usually prolonged chest pain. Typical characteristics of the pain include:
Duration usually over 20 minutes
Located in the retrosternal area, possibly radiating to the arms (usually to the left arm), back, neck, or the lower jaw
The pain is described as pressing or heavy or as a sensation of a tight band around the chest; breathing or changing posture does not notably influence the severity of the pain.
The pain is continuous, and its intensity does not alter
The symptoms (pain beginning in the upper abdomen, nausea) may resemble the symptoms of acute abdomen. Nausea and vomiting are sometimes the main symptoms, especially in inferoposterior wall ischaemia.
In inferoposterior wall ischaemia, vagal reflexes may cause bradycardia and hypotension, presenting as dizziness or fainting.
Electrocardiogram (ECG) is the key examination during the first 4 hours after pain onset, but normal ECG does not rule out an imminent infarction.
Markers of myocardial injury (cardiac troponins T and I, creatine kinase-MB mass) start to rise about 4 hours after pain onset. An increase of these markers is diagnostic of myocardial infarction irrespective of ECG findings.
Minor signs of myocardial infarction in ECG, see Table 1 in the original guideline document
Nonischaemic Causes of Chest Pain
Illness/condition Differentiating symptoms and signs
Reflux oesophagitis, oesophageal spasm
No ECG changes
Heartburn
Worse in recumbent position, but also while straining, like angina pectoris
The most common cause of chest pain
Pulmonary embolism
Tachypnoea, hypoxaemia, hypocarbia
No pulmonary congestion on chest x-ray
Clinical presentation may resemble hyperventilation.
Both arterial oxygen pressure (PaO2) and partial arterial pressure of carbon dioxide (PaCO2) decreased.
Pain is not often marked.
D-dimer assay positive
Hyperventilation
Hyperventilation Syndrome
The main symptom is dyspnoea, as in pulmonary embolism.
Often a young patient
Tingling and numbness of the limbs, dizziness
PaCO2 decreased, PaO2 increased or normal
Secondary Hyperventilation
Attributable to an organic illness/cause; acidosis, pulmonary embolism, pneumothorax, asthma, infarction, etc.
Spontaneous pneumothorax
Dyspnoea is the main symptom.
Auscultation and chest x-ray
Aortic dissection
Severe pain with changing localization
Type A dissection sometimes obstructs the origin of a coronary artery (usually the right) with signs of impending inferoposterior infarction
Pulses may be asymmetrical
Sometimes broad mediastinum on chest x-ray
New aortic valve regurgitation
Pericarditis
Change of posture and breathing influence the pain.
A friction sound may be heard.
ST-elevation but no reciprocal ST depression
Pleuritis
A stabbing pain when breathing. The most common cause of stabbing pain is, however, caused by prolonged cough
Costochondral pain
Palpation tenderness, movements of chest influence the pain
Might also be an insignificant incidental finding
Early herpes zoster
No ECG changes, rash
Localized paraesthesia before rash
Ectopic beats
Transient, in the area of the apex
Peptic ulcer, cholecystitis, pancreatitis
Clinical examination (inferior wall ischaemia may resemble acute abdomen)
Depression
Continuous feeling of heaviness in the chest, no correlation to exercise
ECG normal
Alcohol-related
A young male patient in a casualty department, inebriated
ST changes resembling those of acute ischaemia
ST segment elevation
Early repolarization in V1–V3. Seen particularly in athletic men ("athlete's heart")
Acute myopericarditis in all leads except V1, aVR. Not resolved with a beta-blocker.
Pulmonary embolism – in inferior leads
Hyperkalaemia
Hypertrophic cardiomyopathy
ECG
ST segment depression
Sympathicotonia
Hyperventilation
Pulmonary embolism
Hypokalaemia
Digoxin
Antiarrhythmics
Psychiatric medication
Hypertrophic cardiomyopathy
Reciprocal ST depression of an inferior infarction in leads V2–V3–V4
Circulatory shock
QRS changes resembling those of Q wave infarction
Hypertrophic cardiomyopathy
Wolff-Parkinson-White (WPW) syndrome
Myocarditis
Blunt cardiac injury
Massive pulmonary embolism (QS in leads V1–V3)
Pneumothorax
Cardiac amyloidosis
Cardiac tumours
Progressing muscular dystrophy
Friedreich's ataxia
ST changes resembling those of a non-Q wave infarction
Increased intracranial pressure – subarachnoid bleed – skull injury
Hyperventilation syndrome
Post-tachyarrhythmia state
Circulatory shock – haemorrhage – sepsis
Acute pancreatitis
Myopericarditis
The main feature of myocardial ischaemia (impending infarction) is usually prolonged chest pain. Typical characteristics of the pain include:
Duration usually over 20 minutes
Located in the retrosternal area, possibly radiating to the arms (usually to the left arm), back, neck, or the lower jaw
The pain is described as pressing or heavy or as a sensation of a tight band around the chest; breathing or changing posture does not notably influence the severity of the pain.
The pain is continuous, and its intensity does not alter
The symptoms (pain beginning in the upper abdomen, nausea) may resemble the symptoms of acute abdomen. Nausea and vomiting are sometimes the main symptoms, especially in inferoposterior wall ischaemia.
In inferoposterior wall ischaemia, vagal reflexes may cause bradycardia and hypotension, presenting as dizziness or fainting.
Electrocardiogram (ECG) is the key examination during the first 4 hours after pain onset, but normal ECG does not rule out an imminent infarction.
Markers of myocardial injury (cardiac troponins T and I, creatine kinase-MB mass) start to rise about 4 hours after pain onset. An increase of these markers is diagnostic of myocardial infarction irrespective of ECG findings.
Minor signs of myocardial infarction in ECG, see Table 1 in the original guideline document
Nonischaemic Causes of Chest Pain
Illness/condition Differentiating symptoms and signs
Reflux oesophagitis, oesophageal spasm
No ECG changes
Heartburn
Worse in recumbent position, but also while straining, like angina pectoris
The most common cause of chest pain
Pulmonary embolism
Tachypnoea, hypoxaemia, hypocarbia
No pulmonary congestion on chest x-ray
Clinical presentation may resemble hyperventilation.
Both arterial oxygen pressure (PaO2) and partial arterial pressure of carbon dioxide (PaCO2) decreased.
Pain is not often marked.
D-dimer assay positive
Hyperventilation
Hyperventilation Syndrome
The main symptom is dyspnoea, as in pulmonary embolism.
Often a young patient
Tingling and numbness of the limbs, dizziness
PaCO2 decreased, PaO2 increased or normal
Secondary Hyperventilation
Attributable to an organic illness/cause; acidosis, pulmonary embolism, pneumothorax, asthma, infarction, etc.
Spontaneous pneumothorax
Dyspnoea is the main symptom.
Auscultation and chest x-ray
Aortic dissection
Severe pain with changing localization
Type A dissection sometimes obstructs the origin of a coronary artery (usually the right) with signs of impending inferoposterior infarction
Pulses may be asymmetrical
Sometimes broad mediastinum on chest x-ray
New aortic valve regurgitation
Pericarditis
Change of posture and breathing influence the pain.
A friction sound may be heard.
ST-elevation but no reciprocal ST depression
Pleuritis
A stabbing pain when breathing. The most common cause of stabbing pain is, however, caused by prolonged cough
Costochondral pain
Palpation tenderness, movements of chest influence the pain
Might also be an insignificant incidental finding
Early herpes zoster
No ECG changes, rash
Localized paraesthesia before rash
Ectopic beats
Transient, in the area of the apex
Peptic ulcer, cholecystitis, pancreatitis
Clinical examination (inferior wall ischaemia may resemble acute abdomen)
Depression
Continuous feeling of heaviness in the chest, no correlation to exercise
ECG normal
Alcohol-related
A young male patient in a casualty department, inebriated
ST changes resembling those of acute ischaemia
ST segment elevation
Early repolarization in V1–V3. Seen particularly in athletic men ("athlete's heart")
Acute myopericarditis in all leads except V1, aVR. Not resolved with a beta-blocker.
Pulmonary embolism – in inferior leads
Hyperkalaemia
Hypertrophic cardiomyopathy
ECG
ST segment depression
Sympathicotonia
Hyperventilation
Pulmonary embolism
Hypokalaemia
Digoxin
Antiarrhythmics
Psychiatric medication
Hypertrophic cardiomyopathy
Reciprocal ST depression of an inferior infarction in leads V2–V3–V4
Circulatory shock
QRS changes resembling those of Q wave infarction
Hypertrophic cardiomyopathy
Wolff-Parkinson-White (WPW) syndrome
Myocarditis
Blunt cardiac injury
Massive pulmonary embolism (QS in leads V1–V3)
Pneumothorax
Cardiac amyloidosis
Cardiac tumours
Progressing muscular dystrophy
Friedreich's ataxia
ST changes resembling those of a non-Q wave infarction
Increased intracranial pressure – subarachnoid bleed – skull injury
Hyperventilation syndrome
Post-tachyarrhythmia state
Circulatory shock – haemorrhage – sepsis
Acute pancreatitis
Myopericarditis
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