C16. What is the Differential Diagnosis of Central Chest Pain? Flashcards
name somatic sources of chest pain
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.
what is the nature of somatic pain
Nature: Typically sharp, stabbing, and well-localized.
name examples of visceral pain
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.
what is the nature of visceral chest pain
Nature: Typically dull, aching, nauseating, and poorly localized.
what are 3 confusing additional features sometimes associated with chest pain
radiating pain
referred pain
acute/chronic pain
what is radiating pain and examples please
pain felt in centre of chest that spreads to either upper limbs, back or neck
what is referred pain and please give examples
pain felt at a site remote from the area tissue of damage in the chest such as upper limbs, back and neck
what do sympathetic nerves do
increase heart rate and increase contractility
what do parasympathetic nerves do
decrease heart rate
what are visceral afferent nerves
- pain fibres that travel to spinal cord alongside sympathetic nerves
- reflex afferents (eg. from baroreceptors) travel mainly in the vagus nerve (and some in CN XI)
Presynaptic Sympathetic Fibers travel inferiorly down within the spinal cord tracts and exit where
exit the spinal cord through the spinal nerves located between T1 and L2/3 (thoracolumbar)
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
- synapse at the same level
- travel up
- travel down
- pass through to prevertebral ganglia
- pass through adrenal medulla
- synapse at the same level
- travel up
- travel down
- pass through to prevertebral ganglia
- pass through adrenal medulla
explain these
- can enter the ganglion at the same level they exited and synapse there
- can travel up the sympathetic chain to another ganglion and synapse there
- can travel down the sympathetic chain to another ganglion and synapse there
- 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).
- 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.
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 ……
abdominopelvic splanchnic
adrenaline
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).
abdominopelvic splanchnic
prevertebral
celiac
what are the postsynaptic sympathetic nerves to heart and lungs called
cardiopulmonary splanchnic nerves
to a midline organ such as the heart there will be what kind of sympathetic innervation
bilateral
which cranial nerves carry parasympathetic signals from the CNS to the organs
CN III, VII, IX and X
Oculomotor, facial, glossopharyngeal, Vagus
Pelvic Splanchnic nerves are Sympathetic or parasympathetic
Parasympathetic
what is a Cardiac Plexus:
A network of nerves located near the heart that contains both sympathetic and parasympathetic fibers.
A network of nerves located near the heart that contains both sympathetic and parasympathetic fibers are called
a cardiac plexus
sympathetic has thoracolumbar outflow what does parasympathetic have
cranial sacral outflow
poking T5 dermatome causes what
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)
between the frontal lobe and parietal lobe is what
the central sulcus
what is in front of the central sulcus (into the frontal lobe)
precentral gyrus of the frontal lobe
what is behind the central sulcus (into the parietal lobe)
post central gyrus of the parietal lobe
action potentials originating at precentral gyrus bring about what
contractions of the body wall (somatic) skeletal muscle
(somtomotor)
Action potentials arriving at the postcentral gyrus does what
bring body wall (somatic) sensations into ‘‘consciousness’’
between the frontal lobe and temporal lobe there is what
lateral fissure
what is the sensory humunculus
A representation of the body in the brain, showing which areas of the body project sensations to specific regions of the somatosensory cortex.
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?
the sensory homunculus
'’sharp’’ somatic central pain sources example one HZ
Shingles - Herpes Zoster
- reactivation of dormant virus in posterior root ganglion
- pain felt anywhere in dermatome
- T4/T5 cause chest pain
- patient preceds blisters
'’sharp’’ somatic central pain sources example 2 MJ&B
Muscle, joint and bone
- pectoralis major or intercostal muscle strain
- dislocated costochondral joint
- costovertebral joint inflammation
- slipped thoracic intervertebral disc
'’sharp’’ somatic central pain sources example 3 PP & FP
Parietal Pleura & Fibrous Pericardium
- Pleurisy
- Pericarditis
