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- W2313136479 abstract "OPEN ACCESSMarch 14, 2014An Atypical Cause of Chest Pain: An Octopus Trap Eduardo Hariton, Michael Lester, Jeremy Richards Eduardo Hariton Harvard Medical School Google Scholar More articles by this author , Michael Lester Harvard Medical School Google Scholar More articles by this author , Jeremy Richards Beth Israel Deaconess Medical Center Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9732 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: This clinical case-based simulation is intended to provide learners with experience evaluating acute chest pain in a safe and controlled environment while challenging them to think about the underlying physiology and to develop alternative diagnoses (e.g., Takotsubo cardiomyopathy), as well as to examine rare causes when confronted with unexpected results. The simulation is based on a real patient case seen by one of the authors wherein a patient received an incorrect diagnosis at an outside hospital and was transferred to the author's hospital for catheterization for a presumed myocardial infarction. The simulation is targeted at second-, third-, or fourth-year medical students, residents, and/or cardiology fellows. Methods: Students working in groups of four to eight are expected to (1) evaluate the patient with acute chest pain in a hospital setting, (2) demonstrate the ability to asses a differential diagnosis by ordering appropriate testing, and (3) exercise both critical thinking and communication/teamwork in arriving at a differential diagnosis and determining next steps in the evaluation of the patient. Results: The simulation was well received by participants (medical students) during a session. They felt that the material covered reinforced their knowledge of topics discussed and that it was quite realistic compared to situations they had experienced in the emergency department. The participants were all satisfied with the experience. Discussion: This simulation works best when students are encouraged to think for themselves and use their physiologic reasoning to reach a new conclusion and broaden their differential. Ideally, students would have sufficient background to reach the correct diagnosis, although we have not always found this to be the case in practice. We feel that a preceding lecture involving causes of acute coronary syndrome including Takotsubo cardiomyopathy would be beneficial as it may enable students to more appropriately address the case and reach the correct conclusion. Finally, it is our hope that this simulation will encourage students to engage in physiologic thinking rather than pure pattern recognition (i.e., “Why would a woman with sudden onset chest pain become acutely hypotensive?” vs. “chest pain + troponins = M/I = balloon”). Educational Objectives By the end of this session, learners will be able to: Demonstrate a clinical diagnostic approach to chest pain.Develop a rational differential diagnosis for chest pain in the context of this case scenario.Apply a focused and rational management strategy to a patient presenting with chest pain.Demonstrate understanding of the presentation, pathophysiology, management, and natural disease course of Takotsubo cardiomyopathy. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Atypical Chest Pain Instructor's Guide.docx Hariton Lester Simulation Interest Group Scenario Template.docx Electrocardiogram.png Chest X-ray.png left ventriculogram at the beginning of left ventricular systole.png left ventriculogram at the end of left ventricular systole with obvious apical ballooning.png To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationHariton E, Lester M, Richards J. An Atypical Cause of Chest Pain: An Octopus Trap. MedEdPORTAL. 2014;10:9732. https://doi.org/10.15766/mep_2374-8265.9732 Copyright & Permissions© 2014 Hariton et al. This is an open-access article distributed under the terms of the Creative Commons Attribution license.KeywordsCardiomyopathiesChest PainStress Induced CardiomyopathyCardiology Disclosures None to report. Funding/Support None to report. Loading ..." @default.
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%2C%20as%20well%20as%20to%20examine%20rare%20causes%20when%20confronted%20with%20unexpected%20results.%20The%20simulation%20is%20based%20on%20a%20real%20patient%20case%20seen%20by%20one%20of%20the%20authors%20wherein%20a%20patient%20received%20an%20incorrect%20diagnosis%20at%20an%20outside%20hospital%20and%20was%20transferred%20to%20the%20author's%20hospital%20for%20catheterization%20for%20a%20presumed%20myocardial%20infarction.%20The%20simulation%20is%20targeted%20at%20second-%2C%20third-%2C%20or%20fourth-year%20medical%20students%2C%20residents%2C%20and%2For%20cardiology%20fellows.%20Methods%3A%20Students%20working%20in%20groups%20of%20four%20to%20eight%20are%20expected%20to%20(1)%20evaluate%20the%20patient%20with%20acute%20chest%20pain%20in%20a%20hospital%20setting%2C%20(2)%20demonstrate%20the%20ability%20to%20asses%20a%20differential%20diagnosis%20by%20ordering%20appropriate%20testing%2C%20and%20(3)%20exercise%20both%20critical%20thinking%20and%20communication%2Fteamwork%20in%20arriving%20at%20a%20differential%20diagnosis%20and%20determining%20next%20steps%20in%20the%20evaluation%20of%20the%20patient.%20Results%3A%20The%20simulation%20was%20well%20received%20by%20participants%20(medical%20students)%20during%20a%20session.%20They%20felt%20that%20the%20material%20covered%20reinforced%20their%20knowledge%20of%20topics%20discussed%20and%20that%20it%20was%20quite%20realistic%20compared%20to%20situations%20they%20had%20experienced%20in%20the%20emergency%20department.%20The%20participants%20were%20all%20satisfied%20with%20the%20experience.%20Discussion%3A%20This%20simulation%20works%20best%20when%20students%20are%20encouraged%20to%20think%20for%20themselves%20and%20use%20their%20physiologic%20reasoning%20to%20reach%20a%20new%20conclusion%20and%20broaden%20their%20differential.%20Ideally%2C%20students%20would%20have%20sufficient%20background%20to%20reach%20the%20correct%20diagnosis%2C%20although%20we%20have%20not%20always%20found%20this%20to%20be%20the%20case%20in%20practice.%20We%20feel%20that%20a%20preceding%20lecture%20involving%20causes%20of%20acute%20coronary%20syndrome%20including%20Takotsubo%20cardiomyopathy%20would%20be%20beneficial%20as%20it%20may%20enable%20students%20to%20more%20appropriately%20address%20the%20case%20and%20reach%20the%20correct%20conclusion.%20Finally%2C%20it%20is%20our%20hope%20that%20this%20simulation%20will%20encourage%20students%20to%20engage%20in%20physiologic%20thinking%20rather%20than%20pure%20pattern%20recognition%20(i.e.%2C%20%E2%80%9CWhy%20would%20a%20woman%20with%20sudden%20onset%20chest%20pain%20become%20acutely%20hypotensive%3F%E2%80%9D%20vs.%20%E2%80%9Cchest%20pain%20%2B%20troponins%20%3D%20M%2FI%20%3D%20balloon%E2%80%9D).%20Educational%20Objectives%20By%20the%20end%20of%20this%20session%2C%20learners%20will%20be%20able%20to%3A%20Demonstrate%20a%20clinical%20diagnostic%20approach%20to%20chest%20pain.Develop%20a%20rational%20differential%20diagnosis%20for%20chest%20pain%20in%20the%20context%20of%20this%20case%20scenario.Apply%20a%20focused%20and%20rational%20management%20strategy%20to%20a%20patient%20presenting%20with%20chest%20pain.Demonstrate%20understanding%20of%20the%20presentation%2C%20pathophysiology%2C%20management%2C%20and%20natural%20disease%20course%20of%20Takotsubo%20cardiomyopathy.%20Sign%20up%20for%20the%20latest%20publications%20from%20MedEdPORTAL%20Add%20your%20email%20below%20FILES%20INCLUDEDReferencesRelatedDetails%20FILES%20INCLUDED%20Included%20in%20this%20publication%3A%20Atypical%20Chest%20Pain%20Instructor's%20Guide.docx%20Hariton%20Lester%20Simulation%20Interest%20Group%20Scenario%20Template.docx%20Electrocardiogram.png%20Chest%20X-ray.png%20left%20ventriculogram%20at%20the%20beginning%20of%20left%20ventricular%20systole.png%20left%20ventriculogram%20at%20the%20end%20of%20left%20ventricular%20systole%20with%20obvious%20apical%20ballooning.png%20To%20view%20all%20publication%20components%2C%20extract%20(i.e.%2C%20unzip)%20them%20from%20the%20downloaded%20.zip%20file.%20Download%20editor%E2%80%99s%20noteThis%20publication%20may%20contain%20technology%20or%20a%20display%20format%20that%20is%20no%20longer%20in%20use.%20CitationHariton%20E%2C%20Lester%20M%2C%20Richards%20J.%20An%20Atypical%20Cause%20of%20Chest%20Pain%3A%20An%20Octopus%20Trap.%20MedEdPORTAL.%202014%3B10%3A9732.%20https%3A%2F%2Fdoi.org%2F10.15766%2Fmep_2374-8265.9732%20Copyright%20%26%20Permissions%C2%A9%202014%20Hariton%20et%20al.%20This%20is%20an%20open-access%20article%20distributed%20under%20the%20terms%20of%20the%20Creative%20Commons%20Attribution%20license.KeywordsCardiomyopathiesChest%20PainStress%20Induced%20CardiomyopathyCardiology%20Disclosures%20None%20to%20report.%20Funding%2FSupport%20None%20to%20report.%20Loading%20...%22){kind=link}