Chest Flashcards
What are the 7 serious conditions that can present with chest pain?
Myocardial ischaemia (CHD or AMI) Aortic dissection Pulmonary embolism Endocarditis Pericarditis Pneumonia Penumothorax
What are the red flags and signs that can indicate pericarditis?
- sudden onset severe retrosternal pain
- pain agg. by lying down
- tachycardia
- dysphagia
- restlessness / anxiety
- fatigue
What are the red flags and signs that can indicate a tension pneumothorax?
- rapidly progressive SOB
- central cyanosis
- tracheal / mediastinal displacement
What are the red flags and signs that can indicate an obstructive tumour?
- stridor
- dyspnoea
- SVC syndrome (face and UL oedema)
What are the red flags and signs that can indicate a compressive tumour?
- Horner’s syndrome
- upper limb neuro SSX
What are the red flags that indicate a myocardial ischaemia?
- chest pain maybe radiating to shoulder and arm (left more than right), jaw, neck, interscap region
- SOB / dyspnoea / tachypnoea
- pallor / cyanosis
- tachycardia / palpitations / thready pulse
- sweating
- dizziness
- mental state change (distress, confusion)
- weakness / fatigue / collapse
- SSX agg. by exertion and stress
What are red flags for mechanism and pattern in a chest pain presentation?
- traumatic onset
- acute onset
- SSX agg. by exertion
What are the signs of pneumonia?
- tachypnoea
- dypnoea
- productive cough
- chest pain agg. by inspiration, coughing
- may also have fever / chills, sweating, fatigue / malaise
What are the classic SSX associated with cardiomegaly?
- decreased urination in the day and increased urination at night
- SOB / dyspnoea
- tachycardia / thready pulse / arrythmias
- dizziness / fatigue / weakness
What are the SSX of an aortic dissection?
- sudden onset severe chest pain, may present as pain in the Tx or Lx
- pain is ripping / tearing / stabbing in quality
- mental state changes (distress, anxiety, loss of consciousness)
- SOB
- difficulty speaking
- loss of vision
- difficulty walking / unilateral paralysis
- may have a pulsatile abdo mass
What are the 7 common musculoskeletal conditions that could cause chest pain?
Muscle strain Side strain SC sprain Costochondritis Cv/CT sprain Rib fracture Vertebral fracture
Describe the differences in chest pain presentation for cardiovascular, respiratory and musculoskeletal causes
Cardiovascular:
- pain is deep, crushing, retrosternal
- pain is agg. by exertion
- pain can radiate to arms (left more than right), jaw, neck and interscap region
- pain can present in Tx and Lx (aortic dissection)
Respiratory:
- pain is pleuritic (assoc. w/ breathing)
- pain is agg. by inspiration, coughing
- pain rarely radiates
Musculoskeletal:
- pain is well localized
- pain may radiate along affected rib line in rib fracture, CV/CT sprain
- pain is typically aggravated by movement, and relieved by rest, position change, head, NSAIDs
- tender to palpation
Describe the condition of costochondritis including presentation, pathology, findings and treatment
Pain:
- chest wall pain
- pain over costochondral joints, maybe radiating along rib line and/or into UL, Tx
- pain can be severe, and sharp on rib movement and palpation
Agg by:
- coughing, breathing
- exertion
- Tx movement
- palpation
Pathology:
- chronic inflammation of costochondral or chondrosternal joints (most common in ribs 2-5)
- mechanism unknown
- risk factors: arthritis, inflammatory joint conditions, overuse or physical strain, blunt trauma
Findings:
- oedema over joints
- sharp pain with palpation of affected joints, springing of associated rib, anterior rib sprining
- decreased Tx and Tx cage ROM
Treatment:
- self limiting within days-years
- relative rest, NSAIDs, mobilize Tx cage, may tape over joints
Describe the condition of side strain including presentation, mechanisms, findings, and prognosis
Mechanism / pathology:
- strain of the transversalis fascia or internal oblique mm; often IO mm partially tears away from insertion into ribs / costal cartilage 10-12
- typical mechanism: forceful contraction of IO from an overstretched position (common in bowlers, golfers etc), or repetitive microtrauma (coughing, sneezing)
Presentation:
- tightness over lower ribs / costal cartilages
- sharp agg. with movement
Agg by:
- movement, inspiration, lifting, bending over, stretching
Assoc:
- bruising, oedema, decreased strength
Findings:
- decreased ROM Lx sidebending, pain with movement
- pain on palpation ribs 9-12, esp. at mid-axillary line
- decreased strength trunk flexion / rotation, pain with movement
Prognosis:
- SSX reduction 1-3/52
- full recovery 4-6/52
Describe the condition of SC sprain including mechanism, presentation, findings, prognosis
Mechanism:
- grade 1-3 sprain of SC ligaments
- usually blunt force trauma to shoulder or clavicle
- can be insidious onset degeneration
Presentation:
- pain over region of SC joint, maybe radiating to shoulder (if sharp pain consider clavicle Fx / sublax as a DD)
- agg. by shoulder ROM, palpation
- may have oedema, bruising
Findings:
- if clavicle displaced, this can compress vessels behind clavicle: if difficulty breathing or swallowing, or disrupted peripheral blood supply (check radial and brachial pulses and capillary return) needs an urgent medical referral
- decreased shoulder ROM, pain with movement
- pain and laxity with SC springing
Prognosis:
- Grade 1: 2-3/7
- Grade 2: 4-6/52
- Grade 3: surgical repair
