1. Chest Pain Flashcards
Of all the people presenting with chest pain, what percentage is from a cardiac cause vs a non-cardiac cause
25% - Cardiac
75% - Non-cardiac
What are the non-cardiovascular causes of chest pain? Give examples of each type.
GI (peptic ulcer, GORD, pancreatitis, gallstones)
Respiratory (pneumothorax, pneumonia, pulmonary embolism, pleurisy)
Musculoskeletal (Chostochondritis, Herpes Zoster / Shingles)
What is the most common cause of cardiovascular related chest pain
Myocardial ischaemia is responsible for 99.98% of A&E admissions with cardiovascular related chest pain.
Name some of the causes of myocardial ischaemia
The main cause is coronary artery disease, however other causes include
- aortic stenosis
- hypertrophic cardiomyopathy
- tachyarrhymias
- cocaine use
- anaemia
- thyrotoxicosis
What are the main aspects of a history to focus on when dealing with someone with chest pain?
- SOCRATES for pain
- Medications they are on
- Past medical history
- Family medical history
If they have IHD running in their family that has affected people under the age of 40, then it is a strong indicator its hereditary.
What is sudden onset chest pain an indicator of?
Pulmonary embolism
What do these different descriptions of chest pain indicate?
- Heavy / tight
- Severe ripping
- Sharp Stabbing
- Heavy / Tight is an indicator of either ACS or GORD.
- Severe ripping pain is an indicator of aortic dissection
- Sharp stabbing pain is an indicator of pleuritic pain, either from a respiratory cause or a musculoskeletal one.
If someone was having an ACS, where would the pain likely radiate to?
- Left arm / both arms
- Jaw
- Neck
What condition is suspected in someone complaining of chest pain thats radiating to the right shoulder
Cholecystitis
What conditions are suspected in someone with chest pain that radiates to the inter-scapular region of the back?
- Mainly aortic dissection, but can also be
- GORD
- Pancreatitis
- Peptic ulcer
- ACS
What is chest pain that refers to the epigastrium region an indicator of?
This suggests a gastro-oesophageal cause, such as;
- pancreatitis
- peptic ulcer
- gallstones
it can also indicate ACS
What are some associated features of GI related chest pain?
- Nausea
- Vomitting
- Belching
- Indigestion
However, these can also be present in those with an ACS
What condition causes chest pain accompanied with sweating and clammy hands?
- ACS
- Pulmonary embolism
- Aortic Dissection
What condition causes chest pain accompanied with shortness of breath?
- ACS
- All respiratory causes (pneumothorax, pneumonia, PE, pleurisy)
If chest pain only lasts a few seconds, what does this indicate?
It is normally musculoskeletal in nature, and not cardiac
