C16. What is the Differential Diagnosis of Central Chest Pain?

Question 1

name somatic sources of chest pain

Answer 1

Muscular: Pain from muscles in the chest wall.
Joint: Pain from joints, such as the costosternal joints.
Bony: Pain from ribs or sternum.
Intervertebral Disc: Pain from spinal discs.

Question 2

what is the nature of somatic pain

Answer 2

Nature: Typically sharp, stabbing, and well-localized.

Question 3

name examples of visceral pain

Answer 3

Heart & Great Vessels: Pain from the heart or major blood vessels.
Trachea: Pain from the trachea.
Oesophagus: Pain from the esophagus.
Abdominal Viscerae: Pain from abdominal organs.

Question 4

what is the nature of visceral chest pain

Answer 4

Nature: Typically dull, aching, nauseating, and poorly localized.

Question 5

what are 3 confusing additional features sometimes associated with chest pain

Answer 5

radiating pain
referred pain
acute/chronic pain

Question 6

what is radiating pain and examples please

Answer 6

pain felt in centre of chest that spreads to either upper limbs, back or neck

Question 7

what is referred pain and please give examples

Answer 7

pain felt at a site remote from the area tissue of damage in the chest such as upper limbs, back and neck

Question 8

what do sympathetic nerves do

Answer 8

increase heart rate and increase contractility

Question 9

what do parasympathetic nerves do

Answer 9

decrease heart rate

Question 10

what are visceral afferent nerves

Answer 10

1. pain fibres that travel to spinal cord alongside sympathetic nerves
2. reflex afferents (eg. from baroreceptors) travel mainly in the vagus nerve (and some in CN XI)

Question 11

Presynaptic Sympathetic Fibers travel inferiorly down within the spinal cord tracts and exit where

Answer 11

exit the spinal cord through the spinal nerves located between T1 and L2/3 (thoracolumbar)

Question 12

Presynaptic sympathetic fibres from the brain travel down spinal cord and exit at T1-L2/3 and do one of 5 things. name those 5 options

Answer 12

1. synapse at the same level
2. travel up
3. travel down
4. pass through to prevertebral ganglia
5. pass through adrenal medulla

Question 13

1. synapse at the same level
2. travel up
3. travel down
4. pass through to prevertebral ganglia
5. pass through adrenal medulla
   explain these

Answer 13

1. can enter the ganglion at the same level they exited and synapse there
2. can travel up the sympathetic chain to another ganglion and synapse there
3. can travel down the sympathetic chain to another ganglion and synapse there
4. They can pass straight through the sympathetic chain ganglion without synapsing and travel as abdominopelvic splanchnic nerves to synapse in one of the prevertebral ganglia in the abdomen (e.g., celiac ganglion).
5. They can pass straight through the sympathetic chain ganglion without synapsing and travel as abdominopelvic splanchnic nerves directly to the adrenal medulla, where they stimulate the release of adrenaline.

Question 14

presynaptic sympathetic fibres can pass straight through the sympathetic chain ganglion without synapsing and travel as …………….nerves directly to the adrenal medulla, where they stimulate the release of ……

Answer 14

abdominopelvic splanchnic
adrenaline

Question 15

Presynaptic sympathetic fibres can pass straight through the sympathetic chain ganglion without synapsing and travel as ………… ………. nerves to synapse in one of the ………….. ganglia in the abdomen (e.g., ……ganglion).

Answer 15

abdominopelvic splanchnic
prevertebral
celiac

Question 16

what are the postsynaptic sympathetic nerves to heart and lungs called

Answer 16

cardiopulmonary splanchnic nerves

Question 17

to a midline organ such as the heart there will be what kind of sympathetic innervation

Answer 17

bilateral

Question 18

which cranial nerves carry parasympathetic signals from the CNS to the organs

Answer 18

CN III, VII, IX and X
Oculomotor, facial, glossopharyngeal, Vagus

Question 19

Pelvic Splanchnic nerves are Sympathetic or parasympathetic

Answer 19

Parasympathetic

Question 20

what is a Cardiac Plexus:

Answer 20

A network of nerves located near the heart that contains both sympathetic and parasympathetic fibers.

Question 21

A network of nerves located near the heart that contains both sympathetic and parasympathetic fibers are called

Answer 21

a cardiac plexus

Question 22

sympathetic has thoracolumbar outflow what does parasympathetic have

Answer 22

cranial sacral outflow

Question 23

poking T5 dermatome causes what

Answer 23

action potention travels along anterior ramus of T5 into the right dorsal root then rootlets into T5 spinal cord segment then to left hand side up the spinal cord to the cerebral cortex (this demonstrates the swapping over/sides)

Question 24

between the frontal lobe and parietal lobe is what

Answer 24

the central sulcus

Question 25

what is in front of the central sulcus (into the frontal lobe)

Answer 25

precentral gyrus of the frontal lobe

Question 26

what is behind the central sulcus (into the parietal lobe)

Answer 26

post central gyrus of the parietal lobe

Question 27

action potentials originating at precentral gyrus bring about what

Answer 27

contractions of the body wall (somatic) skeletal muscle
(somtomotor)

Question 28

Action potentials arriving at the postcentral gyrus does what

Answer 28

bring body wall (somatic) sensations into ‘‘consciousness’’

Question 29

between the frontal lobe and temporal lobe there is what

Answer 29

lateral fissure

Question 30

what is the sensory humunculus

Answer 30

A representation of the body in the brain, showing which areas of the body project sensations to specific regions of the somatosensory cortex.

Question 31

what is the representation of the body in the brain, showing which areas of the body project sensations to specific regions of the somatosensory cortex called?

Answer 31

the sensory homunculus

Question 32

'’sharp’’ somatic central pain sources example one HZ

Answer 32

Shingles - Herpes Zoster
- reactivation of dormant virus in posterior root ganglion
- pain felt anywhere in dermatome
- T4/T5 cause chest pain
- patient preceds blisters

Question 33

'’sharp’’ somatic central pain sources example 2 MJ&B

Answer 33

Muscle, joint and bone
- pectoralis major or intercostal muscle strain
- dislocated costochondral joint
- costovertebral joint inflammation
- slipped thoracic intervertebral disc

Question 34

'’sharp’’ somatic central pain sources example 3 PP & FP

Answer 34

Parietal Pleura & Fibrous Pericardium
- Pleurisy
- Pericarditis