9. Chest Pain Flashcards
What 5 causes of chest pain require immediate management?
Acute coronary syndrome Aortic dissection Pneumothorax PE Borrhaave's perforation
What are some of the features of ACS?
Sudden onset crushing pain
Radiates to the arm/ jaw
Hx angina/ CVS risk factors
Signs of hypercholesterolemia (xanthomata)
Signs of PVD (carotid bruits, weak pulses)
Signs of Brady-/ Tachyarrythmia
What are 7 features of aortic dissection?
Tearing pain to the back Absent pulse in 1 arm Difference in BP between 2 arms >20 mmHg Hx of HTN New onset aortic regurgitation Pleural effusion Wide mediastinum on CXR
What are 5 features of a pneomothorax?
Pleuritic chest pain + breathlessness
Hyper-inflated chest wall with impaired expansion
Hyper-resonance
Absent breath sounds
Tracheal deviation in tension pneumothorax
What are 3 features of a PE?
Sudden SOB +/- pleuritic chest pain
Tachycardia
Risk factors present: previous DVT, long period of immobility, OCP
What are 2 features of boerhaave’s perforation?
Sudden onset chest pain immediately after vomiting
Signs of pleural effusion
What drugs do patients with ACS needed to be started on?
MONABASH Morphine + metoclopromide Oxygen only if needed to keep sats > 94% Nitrates for vasodilation Antiplatelets- aspirin + other agents Beta blockers Ace inhibitors Statins Heparin
What are the 6 most common causes of acute chest pain?
Musculoskeletal inflammation ACS PE Stable angina Pleurisy Oesophagitis
What blood tests are helpful for diagnosing cause of chest pain?
Troponin (>,3 hours after onset or CK-MB)
Cholesterol (though decreases post-infarct)
FBC: coexisting anaemia
U+Es: Hyperkalaemia can cause arrhythmia
WCC + CRP: inflammation
CBG: T2DM
Amylase: acute pancreatitis
What should STEMI patients receive in addition to MONABASH? What is the alternative to this if unavailable?
Angioplasty
Thrombolysis
