Chest pain diagnostic study of choice: Difference between revisions

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{{Chest pain}}
{{Chest pain}}
{{CMG}}; {{AE}}{{Aisha}}
{{CMG}}; {{AE}}{{Aisha}}
== Overview ==
==Overview==
* The page name should be '''"Diagnostic study of choice for [disease name]"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
<br />
* '''Goal:'''
==Diagnostic Study of Choice==
**To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
**To describe the gold standard test for the diagnosis of [disease name].
**To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
* As with all microchapter pages linking to the main page, at the top of the edit box put <nowiki>{{CMG}}</nowiki>, your name template, and the microchapter navigation template you created at the beginning.
* Remember to create links within WikiDoc by placing <nowiki>[[square brackets]]</nowiki> around key words which you want to link to other pages. Make sure you makes your links as specific as possible. For example, if a sentence contained the phrase anterior spinal artery syndrome, the link should be to [[anterior spinal artery syndrome]] not [[anterior]] or [[artery]] or [[syndrome]].  For more information on how to create links, click [[here]].
* Remember to follow the same format and capitalization of letters as outlined in the template below.
* You should include the name of the disease in the first sentence of every subsection.


== Diagnostic Study of Choice ==
*According to the suspected etiology of the chest pain:
*There is no single diagnostic study of choice for the diagnosis of chest pain caused by acute coronary syndrome, however ECG and cardiac enzymes are the ''most important initial test'', Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) suggest the ECG be obtained and interpreted within 10 minutes of patient presentation in the ED.
**The following result of '''ECG''' is confirmatory of '''Myocardial infarction''' in addition to the Pain described as a substernal pressure or crushing sensation radiated to the left arm, neck and/or jaw:
***ST- T wave changes, '''''OR'''''
***New LBBB, '''''OR'''''
***New Q wave
*Chest X-ray  is the gold standard test for the diagnosis of pneumothorax or pneumonia.
**Order a chest X-ray if the patient presents with any of the following:
*** Fever (>37.8° C / 100° F)
*** Tachypnea (> 20 breaths/min)
*** Tachycardia (> 100 bpm)
*** Decreased breath sounds and crackles in the physical exam
*Echocardiography is the gold standard test for the diagnosis of aortic stenosis or aortic dissection.


===== Template statements =====
* CT angiography is the gold standard test for the diagnosis of pulmonary embolism. A high-sensitivity D-dimer is useful to rule out PE only when negative in low-risk patients.
* The diagnosis of GERD is mainly diagnosed based on the presence of acidic reflux in the esophagus through the ambulatory reflux monitoring.
*Investigations:
**Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
**Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
**Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


=== Gold standard or study of choice: ===
===Diagnostic Criteria===
The cardinal feature of an esophageal stricture is dysphagia
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The following result of [gold standard test] is confirmatory of [disease name]:
** Result 1
** Result 2
* The [name of investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison table for diagnostic studies of choice for [disease name] ====
*Here you should describe the details of the diagnostic criteria.
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>
 
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
Line 72: Line 37:
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
*[Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
*There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].


* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].


* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:  
*[Disease name] may be diagnosed at any time if one or more of the following criteria are met:  
** Criteria 1
**Criteria 1
** Criteria 2
**Criteria 2
** Criteria 3
**Criteria 3


IF there are clear, established diagnostic criteria:
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria:
*There are no established criteria for the diagnosis of [disease name].
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]

Revision as of 02:19, 2 March 2021

Chest pain Microchapters

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Chest Pain in Pregnancy

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Diagnostic Study of Choice

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Physical Examination

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Other Diagnostic Studies

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Case #1

Chest pain diagnostic study of choice On the Web

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Risk calculators and risk factors for Chest pain diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview


Diagnostic Study of Choice

  • According to the suspected etiology of the chest pain:
  • There is no single diagnostic study of choice for the diagnosis of chest pain caused by acute coronary syndrome, however ECG and cardiac enzymes are the most important initial test, Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) suggest the ECG be obtained and interpreted within 10 minutes of patient presentation in the ED.
    • The following result of ECG is confirmatory of Myocardial infarction in addition to the Pain described as a substernal pressure or crushing sensation radiated to the left arm, neck and/or jaw:
      • ST- T wave changes, OR
      • New LBBB, OR
      • New Q wave
  • Chest X-ray is the gold standard test for the diagnosis of pneumothorax or pneumonia.
    • Order a chest X-ray if the patient presents with any of the following:
      • Fever (>37.8° C / 100° F)
      • Tachypnea (> 20 breaths/min)
      • Tachycardia (> 100 bpm)
      • Decreased breath sounds and crackles in the physical exam
  • Echocardiography is the gold standard test for the diagnosis of aortic stenosis or aortic dissection.
  • CT angiography is the gold standard test for the diagnosis of pulmonary embolism. A high-sensitivity D-dimer is useful to rule out PE only when negative in low-risk patients.
  • The diagnosis of GERD is mainly diagnosed based on the presence of acidic reflux in the esophagus through the ambulatory reflux monitoring.
  • Investigations:
    • Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
    • Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
    • Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.

Diagnostic Criteria

  • Here you should describe the details of the diagnostic criteria.
  • Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
  • Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
  • Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
  • Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
  • To view an example (endocarditis diagnostic criteria), click here
  • If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
  • You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
  • [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
  • There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
  • The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
  • The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
  • [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
    • Criteria 1
    • Criteria 2
    • Criteria 3

IF there are clear, established diagnostic criteria: