8. Chest pain Differential Dx Flashcards
Suggest 6 common causes for chest pain.
Cardiac causes:
- Ischaemic (lack of myocyte blood supply)
- Pericarditis (pericardial sac inflammation)
Respiratory causes:
- Pulmonary embolism
- Pneumonia
Upper GI causes:
5. e.g. acid reflux, indigestion
Musculoskeletal causes:
6. e.g. rib fracture, costalcondritis (costal cartilage inflammation)
What are the common causes of pericarditis?
- usually infection, esp. viral
- chest injury
- some cancers and some treatments (e.g. radiotherapy, chemotherapy)
- immune system problems (in chronic/recurring pericarditis)
More common in men and adults.
Where would chest pain caused by ischaemia be located? What quality pain would this be?
- central/retrosternal
- poorly localised
- may radiate to jaw, neck, shoulder, (left arm)
- dull pain (pressure, heaviness)
Where would chest pain caused by pericarditis be located? What quality pain would this be?
- central/retrosternal
- localised to anterior chest
- may have referred pain in shoulder
- sharp pain
Where would chest pain caused by pneumonia be located? What quality pain would this be?
- vague, often lateral
- dull pain
Where would chest pain caused by pulmonary embolism be located? What quality pain would this be?
- well localised
- absent or sharp pain
Where would chest pain caused by upper GI problems be located?
- central or running up into chest
- burning pain
Where would chest pain caused by musculoskeletal problems be located?
- well localised
- sharp pain
Why might someone with pericarditis have referred pain in shoulder?
Due to diaphragm irritation - diaphragm innervated by phrenic nerve which shares C3, 4 and 5 with shoulder dermatomes.
What are the differences between visceral and somatic chest pain?
- Visceral pain (heart and lungs)
- dull, poorly localised
- worsened with exertion - Somatic pain (pericardial and pleural sac)
- sharp, often well localised
- worsened by inspiration, coughing or positional mov.
Which factors aggravate or relieve ischaemic chest pain?
Aggravates: exertion
Relieves: rest (sometimes)
Which factors aggravate or relieve pericarditis chest pain?
Aggravates:
- chest wall mov. - inspiration/coughing
- lying flat
Relieves: sitting up and leaning forward
Which factors aggravate or relieve pulmonary embolism chest pain?
Chest wall movement: inspiration/coughing
Which factors aggravate or relieve upper GI-caused chest pain?
- lying flat
2. food intake
Which factors aggravate or relieve MSK-caused chest pain?
Chest wall movement: inspiration/coughing
