Case 6 Flashcards
What are symptoms of dizziness and visual disturbance classic for?
Hypotension
What is hypotension sometimes triggered by?
Volume depletion and skipping meals
What are the symptoms of Precordial Catch syndrome?
Chest pain, unrelated to exercise or meals. Chest pain reproducible with palpation. Otherwise, normal physical exam.
What is the differential diagnosis for chest pain?
Precordial catch syndrome, Musculoskeletal/costochondritis, GI/GERD, Cardiac, Respiratory/asthma.
What are the primary objectives of a sports pre participation physical exam?
Ensure adolescent athlete is healthy enough to participate in rigors of interscholastic competition. Meet legal and insurance requirements. Ensure cardiovascular health: In particular, the absence of undiagnosed cardiac illnesses such as hypertrophic cardiomyopathy, which could place the student athlete at significant risk of sudden cardiac death. Ensure neurological health. Detect conditions that may predispose to injury (eg musculoskeletal or neurological)
What are the secondary objectives of a sports pre participation physical exam?
Assess general health. Counsel on health-related issues. Assess fitness level for specific sports.
How do you evaluate chest pain in teenagers?
Chest pain is the second most common referral to pediatric cardiologists. In most cases, possible to make a correct diagnosis by careful history and examination.
What is a good mnemonic to use to assess for pain?
OPQESTAAA: OnsetX Position QualityX Radiation Severity TimingX Aggravating factorsX Alleviating factors Associated symptomsX X - especially important in differentiating chest wall pain (or pain of precordial catch syndrome) from cardiac, or ischemic, pain
What is different in onset between chest wall pain and cardiac pain?
Chest wall pain is sporadic and not associated with exertion. Cardiac pain is usually prompted by exertion or stress.
What is different in quality of pain between chest wall and cardiac?
Chest well pain is sharp and well localized. Cardiac pain is pressure and a crushing sensation.
What is the difference in timing between chest wall and cardiac pain?
Chest wall pain is very brief (seconds to a few minutes) and cardiac pain typically lasts 10-15 minutes.
What is the difference between aggravating factors for chest wall pain and cardiac pain?
Chest wall pain is made worse by deep inspiration and can be “broken” with forced deep inspiration. Cardiac pain is NOT affected by deep inspiration.
What associated symptoms with chest pain raises level of concern and requires prompt referral to cardiologist?
Syncope, difficulty breathing, or palpitations associated with chest pain.
What might the presence of fever with chest pain suggest?
Infectious etiology (pericarditis, pneumonia)
What does reproducibility of chest pain imply?
Musculoskeletal, not cardiac origin.