Chapter 26 - Chest pain

Question 1

What are the contributors of chest pain?

Answer 1

Afferent visceral fibers from teh heart, lungs , great vessels and esophagus enter the same thoracic dorsal ganglia

Vague chest pain can be from any of those organs due to overlap

Question 2

List 6 critical causes of chest pain

Answer 2

CV

1) acute MI /ACS
2) aortic dissection
3) cardiac tamponade

PULMONARY

1) PE
2) tension pneumothorax
3) hemothorax

GI
1) esophageal rupture (boerhave’s sydrome (full thickness tear)- pt can complain of back pain)

Question 3

what are some ofthe common and uncommon causes of chest pain based on systems:

Answer 3

Other than the big 6 diagnosis, these are the other causes to think of:

1) CARDIO (cocaine induced-angina/vasospasm)
2) PULMONARY
3) GI (Mallory-Weiss (mucosal tear); cholecystitis; pancreatitis)
4) MSK (muscle strain; rib fracture; costochondritis; chest wall pain)
5) NEURO (spinal root compression; thoracic outlet syndrome; herpes zoster; post-herpetic neuralgia)
6) OTHER (psychological; hyperventilation)

Question 4

Outline your approach to the person with sudden onset severe chest pain

Answer 4

MOVIE
            Monitors
            Oxygen
            Vitals (including glucose)
            IV
            Equipment and environment (resus bed, monitored environment)
        Labs
        ECG
        Portable CXR
        Full history and physical