Differential Diagnosis For Chest Pains [自动保存的]
中医疾病鉴别诊断学（DifferentialdiagnosisofChineseMedicine）
中医疾病鉴别诊断学（Differential diagnosis of ChineseMedicine）A traditional Chinese medicine, fullness of differential diagnosis: 1. with stomach fullness: both disease with stomach, and often appear simultaneously. However, stomach pain mainly in order to Weipi fullness discomfort for patients, involving the thoracic diaphragm; stomach syndrome, stomach can have tenderness, while Weipi onset is slow, the pressure of the pain, the difference was significant; the patients without obvious epigastric pain, it is fullness. 2.: the two chest fullness and disease are in the epigastrium, and thoracic with heart to hard and with full belly, according to characteristics of fullness in the heart; stomach, in full without pain, hand pressing, touch the invisible characteristics. The patients with epigastric and abdominal pressure of ROEN, no pain, not knot chest. 3. fullness and bulge: two have a sense of fullness, abdominal swell like a drum bulge shape characteristic, then consciously Weipi stuffiness, swell form; bulging disease in the areca, or tangible or intangible, Weipi disease in the stomach cavity, are invisible; according to the acute abdominal skin swelling, stomach according to the fullness of the soft.4. with the fullness of chest pain: Weipi often accompanied by chest stuffiness, occasional chest abdominal discomfort, but the two have the disease in mind and disease in the stomach, can be the difference between. Chest pain is chest Yang stagnation, stasis of blood, heart pulse dystrophy for patients with chest pain, chest tightness, shortness of breath and main symptoms, accompanied by palpitations, knotted pulse and other symptoms; Weipi, dysfunction of spleen and stomach, lifting our stomach congestion caused by the loss, with fullness in thestomach filled with nausea uncomfortable many main disease. With food to eat is redu。
胸水ADA与LDH检测的临床意义
胸水ADA与LDH检测的临床意义目的评价胸腔积液腺苷脱氨酶（ADA）、乳酸脱氢酶（LDH）在恶性胸水及结核性胸水中的价值。
方法对88例患者（恶性49例，结核性39例），每例均检测患者胸水ADA、LDH。
结果恶性胸水组LDH水平显著高与结核组（P ＜0.01），而其ADA显著低于结核组（P＜0.01）。
胸水ADA和LDH联合检测，对恶性胸水判别正确率为97.8%。
结论LDH、ADA可作为良恶性胸水鉴别的参考指标。
Abstract：Objective To evaluate the pleural fluid adenosine deaminase （ADA），lactate dehydrogenase （LDH）in malignant pleural effusion and Tuberculous Hydrothorax value. Methods 88 patients （49 malignant，39 cases of tuberculosis），each patient was detected in patients with pleural effusion ADA，LDH. Results The malignant pleural effusion LDH levels were significantly higher in group with tuberculosis group （P < 0.01）. The combined detection of ADA and LDH in pleural effusion，malignant pleural effusion of correct identification rate of 97.8%. Conclusion LDH，ADA can be used as a reference index in differential diagnosis of benign and malignant chest water.Key words：Pleural；ADA；LDH渗出性胸水可有多种原因引起，其中恶性胸水在渗出性胸水中占首位。
急诊胸痛的病因学调查与分析
中国心血管病研究2021年2月第19卷第2期Chinese Journal of C ardiovascular Research,Februaiy2021・Vol.19,No.2•117-临床研究急诊胸痛的病因学调查与分析耿涛薛军胡大一王佳张晓雨基金项目：北京市科技计划课题(D09050020405II)作者单位:100028北京市，应急总医院干部医疗及老年医学科(耿涛、F•佳)，超声心动图室(薛军)；北京大学人民医院心脏中心(胡犬一)；首都医科大学公共卫生学院流行病与卫生统计学系(张晓雨)通信作者：胡人，E-mail:*******************.cn【摘要】目的探讨急诊内科胸痛患者就医途径和病因学构成和相关辅助检查完善情况，为进一步制定合理的诊治方案提供依据方法收集2017年8月至2019年8月因胸痛及胸痛等同症状至应急总医院急诊内科就诊的患者，使用统一表格记录入选患者的一般资料、既往病史、发病时间、到达急诊时间、胸痛特点、实验室检查、心电图诊断及影像学结果，初步诊断和急诊的治疗情况，确定诊断和心血管不良事件：所有数据经SPSS25.0统计软件进行统计学处理结果胸痛患者就医的主要方式为自行前往医院(84.7%),但急性心肌梗死患者以救护车转运的比例(38.6%)高于其他原因胸痛患者(14.7%)。
非心源性胸痛(共537例)占胸痛病因比例较高(46.5%),心源性胸痛的主要原因为冠心病(共351例)(30.4%)。
冠心病患者疼痛部位中位于胸骨后的患者为152例,位于左侧胸部的患者数量为138例•与非冠心病患者相同疼痛部位的患者数量比较均有统计学意义(PV0.001)。
一些常用的急诊辅助检查在急诊胸痛患者屮完成程度好，并且表明适用于冠心病的诊断及鉴别诊断中(P>0.05)结论急诊胸痛患者院前转运和急诊室检查评估均应以科学的研究结果为依据，这不仅可以减少疾病危险性和降低漏诊误诊率，同时能够使患者得到科学的治疗，从而降低病死率和并发症的发生【关键词】胸痛；病因学；冠状动脉疾病doi:10.3969/j.issn.1672-5301.2021.02.005中图分类号R541.4文献标识码A文章编号1672-5301(2021)02-0117-05Survey and analysis of etiologies for patients with chest pain and those with coronary heart disease in ER ofsome hospitalGENG Tao,XUE Jun,HU Da~yi,WANG Jia,ZHANG Xiao-yu.Cadre Medical and Geriatrics Department(GENG Tao,WANG Jia),Echocardiography Room(XUE Jun),Emergency General Hospital,Beijing100028,China；Heart Diseases Center Peking University People's Hospital,Beijing100044,China{HU Da-yi)；Department of Epidemiology and Health Statistics,School of Public Health,Capital Medical University,Beijing100069,China(ZHANG Xiao-yu)Corresponding author:HU Da-vi,E-mail:dayi.hu@[Fund program]Science and Technology Project of Beijing(D0905002040511)[Abstract]Objective To explore the way of seeking medical treatment and etiological composition ofpatients with chest pain and the improvement of relevant auxiliary examinations and provide the basis for makingreasonable diagnoses and treatment plans.Methods Select the emergency room(ER)patients with chest pain orequivalent syndrome in Emergency General Hospital from August2017to August2019.A total of1156patientswere enrolled in the study.Among them,633were males and523females,which separately accounts for55%and45%of the total participants.The data(medical history,onset time,arrival time of emergency,chest paincharacteristics,laboratory examinations,electrocardiograph(ECG)diagnosis and imaging results,preliminarydiagnosis and treatments,determination of diagnosis and cardiovascular adverse events)were collected by unifiedforms.All the data were processed by the software SPSS25.0.Results The main way for patients with chest painwas to go to hospital by themselves(84.7%),but the proportion of patients with acute myocardial infarctiontransferred by ambulance(38.6%)was higher than that of patients with other causes of chest pain(14.7%).Patients with non-cardiogenic chest pain were537which accounted for46.5%of the causes of chest pain and the中国心血管病研究2021年2月第19卷第2期Chinese Journal of C ardiovascular Research,February2021,Vol.19,No.2•118«patients with CHD were351(30.4%).Among the CHD patients,152were located in the posterior sternum and138were located in the left chest,which were statistically significant compared with the patients without CHD inthe same pain sites(P<0.001).Some commonly used emergency auxiliary examinations were well completed inthe emergency chest pain patients and showed that they were suitable for the diagnosis and differential diagnosis ofcoronary heart disease(P>0.05).Conclusion Pre-hospital transfer and emergency room examination evaluationof emergency chest pain patients should be based on scientific research results,which can not only reduce the riskand reduce the misdiagnosis rate,but also can get scientific treatment,so as to reduce the mortality and complications.[Key words]Chest pain；Etiology；Coronary heart disease胸痛是急诊患者中常见的主诉之一，占全部急诊就诊患者的5%旳。
能谱（Revolution）CT_胸腹联合胸痛三联CTA_扫描对急性胸痛患者疾病的差异分析
能谱（Revolution ）CT 胸腹联合胸痛三联CTA 扫描对急性胸痛患者疾病的差异分析左明飞左明飞，，温丽娟温丽娟，，焦宇齐齐哈尔医学院附属第三医院放射影像科，黑龙江齐齐哈尔 161000摘要 目的 分析能谱CT 胸腹联合胸痛三联CT 血管造影术（computed tomography angiography, CTA ）扫描对急性胸痛患者疾病的差异。
方法 选取2022年9月—2023年2月齐齐哈尔医学院附属第三医院急诊收治的50例胸痛患者为研究对象，按照扫描时监测的心率分为低心率组（≤75次/min ）和高心率组（>75次/min ），各25例，所有患者均行能谱CT 胸腹联合胸痛三联CTA 扫描，对比两组不同血管节段管腔平均CT 值、SNR 、CNR 。
结果 低心率组和高心率组患者肺动脉干的CT 值分别为（383.20±67.34）、（371.76±59.35）HU ，信噪比（signal noise ratio, SNR ）分别为（10.35±2.65）、（10.65±2.99），噪声比（contrast noise ratio, CNR ）分别为（19.75±3.16）、（20.18±4.65），两组比较，差异无统计学意义（t =0.637、0.375、0.388，P >0.05）。
两组患者主动脉、肺动脉、冠状动脉各个血管节段平均CT 值、SNR 、CNR 比较，差异无统计学意义（P >0.05）。
结论 能谱（Revolution ）CT 胸腹联合胸痛三联CTA 诊断在不同心率的急性胸痛患者中应用无差异，可以满足临床应用的需求。
关键词 胸腹能谱CT ；胸痛三联CT 血管造影术；急性胸痛中图分类号 R 445 文献标志码 Adoi10.11966/j.issn.2095-994X.2023.09.08.01Differential Analysis of Disease in Patients with Acute Chest Pain by Revolution CT Chest and Abdomen Combined with Triple CTA Scanning for Chest PainZUO Mingfei, WEN Lijuan, JIAO YuDepartment of Radiologic Imaging, the Third Affiliated Hospital of Qiqihar Medical College, Qiqihar, Heilongjiang Province, 161000 China Abstract Objective To analysis differential of disease in patients with acute chest pain by revolution CT chest and abdomen combined with triple computed tomography angiograph (CTA) scanning for chest pain. Methods Fifty patients with chest pain admitted to the emergency de⁃partment of the Third Affiliated Hospital of Qiqihar Medical College from September 2022 to February 2023 were selected as study objects. According to the heart rate monitored at the time of scanning, they were divided into low heart rate group (≤75 beats/min) and high heart rate group (>75 beats/min), with 25 cases in each group. All patients underwent revolution CT chest and abdomen combined with chest pain triple CTA scanning, and the mean CT, SNR, CNR values of the lumen of different vascular segments were compared between the two groups. Re⁃sults The CT values of pulmonary arteries in low heart rate group and high heart rate group were (383.20±67.34) HU and (371.76±59.35) HU, signal noise ratio (SNR) were (10.35±2.65) and (10.65±2.99), and contrast noise ratio (CNR) were (19.75±3.16) and (20.18±4.65), respec⁃tively, and the differences were not statistically significant (t =0.637, 0.375, 0.388, P >0.05). There was no statistically significant difference in the mean CT value, SNR and CNR of each vascular segment of the aorta, pulmonary artery and coronary artery between the patients of two groups(P >0.05). Conclusion There is no difference in the application of revolution CT chest and abdomen combined with triple CTA diagnosis of chest pain in patients with acute chest pain with different heart rates, which can meet the needs of clinical application.Key words Revolution CT chest and abdomen; Chest pain triple CTA; Acute chest pain* 论著 *收稿日期：2023-06-01；修回日期：2023-06-21基金项目：齐齐哈尔市科技计划联合引导项目（LSFGG-2022027）。
多种新型心肌标志物在急诊胸痛患者急性冠脉综合征鉴别诊断中的意义
急诊患者 ３％ ～６％以胸痛作为主诉［１］，是急诊 就诊患者常见病因的第二位［２］，其中 ２０％ ～２５％为 急性 冠 脉 综 合 征 （ａｃｕｔｅｃａｒｄｉａｃｓｙｎｄｒｏｍｅ，ＡＣＳ）。 ＡＣＳ分为心电图有明确提示的 ＳＴ段抬高型心肌梗
死和只能通过心肌特异性标志物来辅助诊断的非 ＳＴ 段抬高型心肌梗死和不稳定性心绞痛［１］。既往研究 发 现，在 急 诊 就 医 的 胸 痛 患 者 中 仅 有 １．５％ ～ ２２．０％［３］可确诊为 ＡＣＳ，因为胸痛就诊于急诊的患
血清CEA联合胸腔积液CEA对恶性胸腔积液的诊断意义
血清CEA联合胸腔积液CEA对恶性胸腔积液的诊断意义王敏;江子丰;方浩徽【摘要】目的探讨联合检测血清癌胚抗原(CEA)、胸腔积液CEA对恶性胸腔积液诊断的临床意义.方法收集了2010年10月至2015年1月,安徽省胸科医院和安徽医科大学第一附属医院349例胸腔积液患者为研究对象,其中有155例肺癌伴胸膜转移患者(简称"恶性胸腔积液"),194例胸腔积液为良性病变包括结核性胸膜炎、肺炎旁胸腔积液和漏出性胸腔积液患者(简称"良性胸腔积液").抽取患者外周血及胸腔积液,并采用电化学发光免疫分析法进行CEA定量分析.结果恶性胸腔积液患者血清CEA和胸腔积液CEA均显著高于良性胸腔积液患者,ROC结果提示血清CEA 联合胸腔积液CEA对于恶性胸腔积液的诊断敏感性提高至0.858,且AUC值升至0.946,具有显著性差异.结论血清CEA联合胸腔积液CEA可以显著提高对恶性胸腔积液的诊断意义.%Objective To investigate the clinical significance of combined detection of serum carcinoembry-onic antigen ( CEA) and pleural effusion CEA in diagnosis of malignant pleural effusion. Methods From January 2010 to January 2015, 349 inpatients with pleural effusion in the Anhui Chest Hospital and the First Affiliated Hospi-tal of Anhui Medical University were involved in present study, including 155 cases of lung cancer complicated with pleural metastasis ( referred to as"malignant pleural effusion", the same below) , 194 cases of benign diseases inclu-ding tuberculosis pleurisy, parapneumonic pleural effusion and leakage of pleural effusion ( referred to as "benign pleural effusion", the same below) . The peripheral blood and pleural effusion were extracted, and CEA quantitative analysis was performed by using the method ofelectrochemical luminescence immunoassay. Results The serum CEA and pleural effusion CEA in malignant pleural effusion were significantly higher than those patients with benign pleural effusion. Receiver operating characteristic curve ( ROC) results suggested the combination of serum CEA and pleural effusion CEA could obviously increase the sensitivity to 0. 858 and AUC to 0. 946. Conclusion Serum CEA com-bined with pleural effusion CEA can significantly improve the diagnostic value of malignant pleural effusion.【期刊名称】《临床肺科杂志》【年(卷),期】2017(022)011【总页数】4页(P2068-2071)【关键词】肺癌;恶性胸腔积液;血清癌胚抗原;胸腔积液癌胚抗原【作者】王敏;江子丰;方浩徽【作者单位】230022 安徽合肥,安徽省胸科医院呼吸二科;230022 安徽合肥,安徽医科大学第一附属医院老年呼吸内科;230022 安徽合肥,安徽省胸科医院呼吸二科【正文语种】中文几乎所有的恶性肿瘤都可以转移至胸膜，引起胸腔积液，我们称之为恶性胸腔积液，其中约75%的恶性胸腔积液是由肺癌、乳腺癌或宫颈癌引起[1-2]。
咯血鉴别诊断病历书写范文
咯血鉴别诊断病历书写范文英文回答：Hemoptysis, or coughing up blood, is a symptom that can be caused by various underlying conditions. As a doctor, it is important to accurately document and differentiate the possible diagnoses in a patient's medical record. Here is an example of how I would write a differential diagnosisfor a patient presenting with hemoptysis:Chief Complaint: Hemoptysis.History of Present Illness: The patient is a 45-year-old male who presents with a complaint of coughing up blood for the past two days. The patient describes the blood as bright red and mixed with his sputum. He denies any associated chest pain, shortness of breath, or fever. The patient reports a history of smoking for 20 years and has recently quit.Differential Diagnosis:1. Acute bronchitis: This is a common cause of hemoptysis and is often associated with a viral respiratory infection. The patient's recent history of cough and smoking increases the likelihood of this diagnosis. However, the absence of fever and chest pain makes it less likely.2. Pulmonary embolism: This is a potentially life-threatening condition in which a blood clot travels to the lungs. The patient's history of smoking and recentcessation puts him at risk for developing blood clots. Symptoms such as shortness of breath and chest pain may not be present initially, but can develop over time.3. Lung cancer: This is a serious concern in patients with a history of smoking. Hemoptysis can be an early signof lung cancer. The patient's age and smoking history increase the suspicion for this diagnosis. Further evaluation with imaging studies, such as a chest X-ray orCT scan, would be necessary to rule out this possibility.4. Tuberculosis: This infectious disease can also present with hemoptysis. The patient's risk factors, suchas smoking and recent cough, make it important to consider this diagnosis. Other symptoms, such as weight loss, night sweats, and a persistent cough, may be present in patients with tuberculosis.5. Bronchiectasis: This is a chronic condition characterized by abnormal widening of the bronchial tubes. Hemoptysis can occur in patients with bronchiectasis due to the presence of dilated blood vessels in the affected areas. The patient's smoking history and chronic cough make this diagnosis a possibility.中文回答：英文回答：咯血，或者咳血，是一种可能由多种潜在疾病引起的症状。
急诊医学-6.CHESTPAIN
Different character of somatic and visceral pain
Visceral pain Somatic pain
(内脏痛）
(躯体痛）
Orignal sites Character
Internal organs,
Viseral pleura
Chest wall, parietal pleura
29
Enhancing CT scanning
30
Pulmonary angiography
A 77-year-old woman had right-sided heart failure despite 3 days of full-dose heparin. Therefore, she underwent right heart catheterization and pulmonary angiography. Her pulmonary arterial pressure was 55/30 mm Hg. Seen on her baseline angiogram (A) were large right middle and right upper lobe pulmonary emboli (arrows). Because of relative contraindications to full-dose thrombolysis (systemic arterial hypertension and mild dementia), the patient underwent combined suction catheter embolectomy and catheterdirected thrombolysis with a bolus pulse spray of 8 mg of tissue plasminogen activator followed by an overnight infusion of 1 mg/hr. Her follow-up angiogram (B) shows marked improvement and reperfusion.
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四大致命性胸痛特征性ECG表现
临床情况 特征性ECG
•
急性心肌梗死
•
V2—V3导联ST段抬高（J点处测量）： ≥0.25 mV（男性＜40岁） ≥0.2 mV（男性≥40岁） ≥0.15 mV（女性） 和（或）其他导联在没有左室肥大和左束支阻滞的情况下ST段（J点处测 量）抬高≥ 0.1 mV。
•
13
主动脉夹层：
14
肺栓 塞
15
其他非致命性 胸痛
16
非心脏性胸痛；NCCP （Noncardiac Chest Pain)
不能解释的胸痛；UCP （Unexplained Chest Pain)
不能解释的胸痛；UCP
定义：在适当的评估之后，
与心脏无关的, 复发性心绞痛样, 或胸骨下的疼痛。
数小时 无放射
制酸剂缓解
影响睡眠
评估检查
评估UCP的食管病因； 食管及胃24hPH监测 胃镜检查 食管测压 奥美拉唑试验:敏78%, 特86% 食管激发实验：伯恩斯坦试验 腾喜龙试验 球囊扩张试验
心因性胸痛（Psychogenic chest pain）
―双心‖医学，―双心‖门诊
胸痛的鉴别诊断
Differential Diagnosis For Chest Pains
贵阳中医学院第二附属医院 贵州省中西医结合医院 心内科 蒋清安
Department of Cardiology, Guiyang Integrated Traditional Chinese and Western HM734 Exercise Testing and Medicine Hospital
致胸痛的食管疾病
胃食管反流病---GERD
Gastroesophageal Reflux Disease
弥漫性食管痉挛
贲门失弛缓
胡桃夹食管
食管裂孔疝
食管肿瘤
GERD的最新全球定义
GERD是一种由胃内容物引起症状或并发症的疾病
食管症状
食管外症状
症状综合征
伴食管破损的综合征
已证实相关
可能相关
•胸骨后痛
特异度为44%
许国铭执笔，中华消化杂志 2002;22(1):7
食管裂孔疝
食管 食管下括约肌 食管裂孔疝 横膈
食管
食管下括约肌 横膈
十二指肠
幽门
出血
胃
溃疡
胃食管连接处 食管 裂孔疝
瓣膜
十二指肠
食管裂孔疝
幽门
胃
正常
临 床 表 现
心血管疾病的典型表现 食管疾病的典型表现 反酸、烧心 伴胸痛 吞咽困难
新出现的右束支传导阻滞，电轴偏移，SIQIII，不恰当的电轴，前壁导联T波 负向，肺性P波。 非特异性，30%患者正常，5%患者ST段太高(RCA > LCA)。 胸导联R丢失和T波倒置，QRS波低振幅、电轴右偏；左侧气胸可产生类似心 肌缺血的心电图改变
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主动脉综合症 气胸
非ST段抬高心梗疑诊
排除
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Bruno, R R; Donner-Banzhoff, N; Sö llner, W; Frieling, T; Mü ller, C; Christ, MThe Interdisciplinary Management of Acute Chest Pain Dtsch Arztebl Int 2015; 112(45): 768-80; DOI: 10.3238/arztebl.2015.0768
冠心病可能性 很低 低 中度 高
HM734 Exercise Testing and Prescription: Cardiorespiratory 8
致命性胸痛标准
可反复出现的下列临床情况之一： 意识受损 呼吸功能不全(SpO2 < 90%) 严重的血压异常（SBP ≤90 mmHg 或≥ 220 mmHg) 心动过速或过缓( 脉搏> 100次/min 或< 60次 /min) 面色苍白、出汗 疼痛对药物治疗无反应
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HM734 Exercise Testing and Prescription: Cardiorespiratory
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反流病的诊断策略
• 症状
- 反流症状问卷调查
• 治疗试验
- 大剂量 PPI 有选择性
H +
内镜检查 食管Leabharlann HPPI试验在GERD诊断中的价值
反流症状
第二军医大学长海医 协和医科大学 •反酸 院 北京协和医院 阳性符合率81% •烧心 解放军301 医院 20mg 上海第二医科大 OME 灵敏度88.1% 2/d×1周 •反食 学瑞金医院 复旦大学药学院
典型反流综合征 反流胸痛综合征
反流性食管炎 反流性狭窄 Barrett 食管 食管腺癌
反流性咳嗽综合征 反流性喉炎综合征 反流性哮喘综合征 反流性蛀牙综合征
咽炎 鼻窦炎 特发性肺纤维化 复发性中耳炎
Vakil N et al. Am J Gastroenterol, 2006;101:1900－20
甲状腺功能减退 心尖球形综合征（Takotsubo心 肌病） 浸润性疾病，如淀粉样变性、 血色素沉着症、结节病、或硬 皮病 心脏毒性药物，如阿霉素、5氟尿嘧啶，赫赛汀，蛇毒 烧伤超过30%的体表面积 横纹肌溶解症 危重病，主要是呼吸衰竭或脓 毒症
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在心肌损伤标记物升高基础上：
Prescription: Cardiorespiratory 1
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特发性食管破裂综合征
HM734 Exercise Testing and Prescription: Cardiorespiratory
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生命体征异常，包括： • 神志模糊 • 意识丧失、 • 面色苍白、 • 大汗及四肢厥冷、 • 低血压、 • 呼吸急促或困难、 • 低氧血症(SpO2<90%) 。
观察
纳入
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临床 伴有 cTn 升高 的常见原因
慢性或急性肾功能不全 严重急性或慢性充血性心力衰竭 高血压危象 快速或缓慢性心律失常 肺动脉栓塞，严重的肺动脉高压 炎症，如心肌炎 急性神经系统疾病，如中风或蛛 网膜下腔出血 主动脉夹层，主动脉瓣病变，或 肥厚型心肌病 心脏挫伤、心脏消融，心脏起搏 器，电复律，或心内膜活检
国外有研究显示，在胸痛患者中，有近60％患者为非心源性胸痛，在非心 源性胸痛患者中，14％可以诊断为惊恐障碍，14％为躯体化障碍，5％为重 度抑郁。 对于以心血管症状为主诉的患者，在排除心血管疾病后，宜优先考虑是由 焦虑和抑郁引起的躯体化症状。
通过辅助检查后排除可能引起胸闷胸痛的病因后，如果患者胸闷或胸痛 通常伴有呼吸困难，持续30min或以上，与用力和运动无关，且患者有 其他情感障碍的迹象。 如焦虑情绪、抑郁情绪或者有惊恐发作的病史，应该引起重视，此时 患者的症状极可能是由于精神心理障碍引起， 可通过心理量表对患者进行心理评分，由于引起胸闷胸痛的常见心理 障碍为：抑郁障碍、焦虑障碍、躯体化障碍。
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肺栓塞
V1—V3导联ST段压低，多数情况下伴T波终末部负向。对应的V4-V9导 联ST段抬高≥ 0.25 mV。 胸前导联ST段压低的同时伴aVR导联ST段≥ 0.05 mV，提示左主干或前降 支近段狭窄。 V7–V9 ≥ 0.05 mV (40岁以下男性≥ 0.1 mV）。 新出现的T波负向。 新出现的左束支阻滞。
无创检查：
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典型心肌 缺血性胸痛
HM734 Exercise Testing and Prescription: Cardiorespiratory
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冠心病筛查Marburg心脏计分标准 （每项计1分）
年龄/性别： （男性≥55岁， 女性≥65岁）； 已患血管疾病； 活动诱发症状； 触摸不能诱发疼痛 患者怀疑胸痛是心脏 原因