4. Chest and Ribs Flashcards
What are the immediate life-threatening cause of spontaneous chest pain?
- Myocardial infarction (MI) and unstable angina
- pulmonary embolism
- Aortic Dissection
- Tension pneumothorax
What are the common Red Flags for Acute chest pain?
- dizziness/ syncope
- pain in arms L>R, jaw
- thoracic back pain
- sweating
- palptations
- pallor
- dyspnoea
Pain on inspiration Past history: -ischemia -diabetes -hypertension
List some musculoskeletal causes for Chest pain?
Nerve:
- herpes Zoster
- intercostal neuritis
Bone:
-Rib fx
Joint: -costochondral junction -Costovertebral or transverse -cervical spine Muscle strain or trigger point
List some possible visceral causes:
Refferal from Pleura, oesophagus, GORD
Cancer:
- Breast- mid-thoracic or upper back
- lung
- oesophageal
- tumors of spinal cord and meninges
Infection:
Pnemonia
Mediastinitis
Pericarditis
What could be some cardiac causes of chest pain?
Angina
MI
Aortic dissection
Pulmonary embolism/ infarction
What would be the probable causes of chest pain.
What are the serious disorders we must rule out?
Angina
- slipping rib
- costochondritis
- psychogenic
- intercostal strains/ tears
Serious Disorders- rule these out
- Cardiovascular referral (MI, aortic dissection, pulmonary embolism/ infarction)
- Neoplasia (myeloma, lung, metastatic)
- Severe infections (pleurisy, infectious endocarditis, osteomyelitis)
- Pneumothorax
- Osteoporosis
What are things to consider if pt isnt responding to care and serious conditions already ruled out?
- Mitral Valve prolapse
- oesophageal spasm
- GORD
- Herpes zoster
- fx rib
- spinal dysfunction (disc lesion of lower C spine could result in chest pain, dysfunction or facet joints are common cause for refferred pain here.
- Anaemia
- anxiety with hyperventilation
-Depression
What would be special concerns with chest and rib pain
- acute chest pain with nausea, pallor, anxiety, vomiting or diaphoresis
- sever fatigue or shortness of breath
- pain unresolved by rest or change in position or worse at night
- Pain that worsens following meals or while inhaling (pericarditis?)
- fainting, dizziness or vertigo
- persistent cough
- coughing up blood.
Anyone presenting with chest pain of a crushing tight nature is having an MI untill proven otherwise
- anyone presenting with chest wall/rib pain must be auscultated
- cardiovascular and respiratory conditions can be life threatening so u should always have these conditions in the back of your mind
hy
Signs and symptoms:
- commonly in young
- unilateral
- pain can radiate to back or abdomen
- pain may be sharp and stabbing
- aggravated by activity, sneexing, coughing and deep breaths
What is it, how would you manage this conditions
Management:
- activity modification
- moist heat and NSAIDS may hel in this self-resolving benign condition
- may require referral for an anaesthetic injection, or corticosteroid injection.
Signs and symptoms:
- posterior thoracic pain
- can radiate to shoulder, arm, chest
- pain or tenderness on paraspinal muscles
What is it?
How would you manage?
Costovertebral or costotransverse joint dysfunction
Management:
- activity modification
- mobilisations or manipulation as appropriate
- ROM exercises
- Pain management
- STT
Signs and symptoms:
- follows a dermatome
- burning pain
- itching
- hyperparaesthesia
- painful red vesicle
- T5-T6 most common
what is it, how would you manage?
Herpes Zoster (shingles)
Management:
-refer for medical evaluation
-anti viral drugs are used if given prior to 3 days after onset
-if later than 3 days, treatment focuses on pain relief
Signs and symptoms:
- usually involves a blunt, traumatic incident except for pathological fx.
- Chest wall pain
What is it?
Management:
Rib Fx
- kinesiotape
- minimize movement- bone healing times
- if suspect multiple fx’s refer for medical evaluation.
Signs and symptoms:
- dull ache in anterior chest near lower sternum
- pain can radiate and simulate MI
- Symptoms may be aggravted by bending forward or lying down
What is it?
How would you manage it?
GORD
Management:
-refer for medical evaluation
Signs and symptoms:
- Pain in the neck or back with anterior chest pain
- aggravated by any movement of teh spine
- percussion over involved segment elicits tenderness
Vertebral osteomyelitis:
-fever is often absent
This must be reffered for medical Evaluation.
