1) ACS

2) Pericarditis - usu. pleuritic, pan-lead ST ↑, PR↓ more sp.

3) Pericardial Tamponade

4) PE - pleuritic, clot risk factors helps.

5) Pneumothorax - pleuritic, sudden, dyspnea.

6) Aortic Dissection - Syncope, tearing, pulse differential in carotid, femoral, radial. Wide mediastinum, pleural effusion.

7) Esophageal Rupture

Typical: Substernal pressure, tightness or heaviness, radiates to jaw, shoulders, back or arms. Associated symptoms of dyspnea, diaphoresis, nausea.

Atypical: Seen in 1) Elderly, 2) Diabetics, 3) Women. Presents as dyspnea without chest pain.

Most powerful predictor of MI: Chest pain that radiates to both arms; an S3 heart sound; and hypotension.

1) Aortic stenosis - CP with exertion, syncope, systolic murmer at base radiates to R carotid Art.

2) Esophagitis - Burning, non-exertional, related to meals, worse lying down better upright.

3) Musculoskeletal - Muscle strain, costochondritis, fracture.

4) Panic attack - Angina-like, assoc. with palpitations, diaphoresis, anxiety.

5) Syndrome X - Angina-like cp in young women, ST↓ on exertion, normal coronaries, unknown cause.

1) EKG (look for Q waves, ST segment changes)

2)