5 Can't Miss Causes of Chest Pain - "Who's your PAPPA"

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5 Can’t Miss Causes of Chest Pain

Anyone who presents with chest symptoms, whether it is chest pain, pressure, shortness of breath, indigestion, or cough, you have to ask, “Who is your PAPPA.” This will assist in finding the proper chest pain diagnosis.  You need to look at them, point to them and say, “Who’s your PAPPA?”

PAPPA is a mnemonic for the high-risk, can’t-miss causes of chest pain, that if you miss and they go home, they could die. If we play the odds, we are obligated to focus our attention toward the acute coronary syndrome.  But, there are other causes of chest pain that are equally as lethal and more elusive.

Trust me when I say that you do not want to come to work and have someone say to you, “Hey, remember that patient you saw the other day”…………because these conversations never end positively. Trust me, it’s not because they sent you a thank you note. More commonly it is that the patient was admitted to another hospital with something wrong, or came back with something bad, or died!

“PAPPA” stands for high-risk, can’t-miss causes of chest pain. The first two, “PA” in “PAPPA” have to do with the heart. The next two, “PP,” have to do with the lungs. And the last “A” is an aneurysm.

P is Pericarditis

A is as Acute coronary syndrome (or acute myocardial infarction)

P is Pneumothorax

P is Pulmonary embolism

A is an aneurysm

There are two main attack strategies to assess acute chest pain, one is a systematic evaluation, and the other is the emergency assessment by the assessment of cardiac enzymes, the EKG/ECG.

I will teach you more about assessing a patient with chest pain, and the most important evaluation of those patients.

Remember to ask every patient complaining of chest pain “Who’s your PAPPA”


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John Bielinski, Jr., MS PAC is a practicing emergency medicine clinician, and has been lecturing nationally for more than ten years, teaching the tactics that have proven invaluable in his career as a medical professional.