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examinations > chest pain > Flashcards

chest pain Flashcards

1
Q

cardiac pain

A

myocardial ischaemia or infarction
cantral, tight or heavy
may radiate to the jaw or left or right arm

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2
Q

vascular pain

A

aortic dissection

very sudden onset, radiates to the back

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3
Q

pleuropericardial pain

A 
pericarditis +- myocarditis 
infective pleurisy 
pneumothorax 
pneumonia 
autoimmune disease 
mesothelioma 
metastatic tumour
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4
Q

pericarditis and myocarditis

A

pleuritis pain, worse when the patient lies down

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5
Q

infective pleurisy

A

pleuritic pain

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6
Q

pneumothorax

A

sudden onset, sharp, associated with dyspnoea

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7
Q

autoimmune disease

A

pleurtic pain

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8
Q

pneumonia

A

often pleuritic associated with fever and dysponea

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9
Q

mesothelioma

A

sever and constant

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10
Q

metastitic tumour

A

severe and constant, localised

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11
Q

chest wall pain may be due to

A 
persistant cough 
muscular strains 
intercostal myositis 
thoracic zoster 
coxsackie B virus infection 
thoracic nerve compression or nfiltration 
rib fracture 
rib tumour, primary or metastatic 
tietze syndrome
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12
Q

persistant cough

A

worse on movement

chest wall tender

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13
Q

muscular strains

A

worse with movement, chest wall tender

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14
Q

intercostal myositis

A

sharp, localised, worse with movement

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15
Q

thoracic zoster

A

severe, follows nerve root distribution, precedes rash

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16
Q

coxsackie B virus

A

pleuritic pain

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17
Q

thoracic nerve compression or infiltration

A

follows nerve root distribution

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18
Q

rib fracture

A

history of trauma, localised tenderness

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19
Q

rib tumour, primary or metastitic

A

constant, severe, localised

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20
Q

tietze syndrome

A

constal cartilage tender

21
Q

GI pain may be due to

A

gastro-oesophageal reflux

diffuse oesophageal spasm

22
Q

gastro oesophageal reflux

A

not related to exertion, may be worse when patient lies down, may wake patient at night (common)

23
Q

diffuse oesophageal spasm

A

relieved by swallowing eg. warm water

24
Q

airway pain may be due to

A

tracheitis
central bronchial carcinoma
inhaled foreign body

pain in throat, breathing painful

25
Q

central pain may be due to

A

panic attacks - often preceeded by anxiety, associated with breathlessness and hyperventilation symtpoms (dizziness, perioral paraesthesia)

26
Q

mediastinal pain may be due to

A

mediastinitis
sarcoid adenopathy
lymphoma

prolonged pain

27
Q

orthopnoea

A

dyspnoea when lying down flat

28
Q

SOB awakening patient

A

paroxysmal noctural dysponoea

29
Q

pain in the calf enduced by excercise and relived at rest

A

intermittant claudication

30
Q

important heart related conditions on past history

A

myocardial infarction, coronary artery bypass grafting (CABG), coronary angioplasty, cardiac pacemaker or defib, ablation treztment for cardiac arythmia, rheumatic fever, chorea, recent dental work, thyroid disease

prior medical examination revealing heart disease

drug treatment (chemotherapy with alkylating agent or 5-flurouracil 5FU

31
Q

improtant findings on family history

A

myocardial infarcts, cardiomyopathy, congenital heart disease, mitral valve prolapse, marfan syndrome

32
Q

unusual coronary artery disease risk factors

A

erectile dysfunction
rhuematoid arthritis and chronic inflammatory rheumatological disease
male sex and advanced age

33
Q

pain from angina is caused by

A

accumulation of ischameic metabolites from complete or partial obstruction of coronary artery

34
Q

character of chest pain

A

tight or heavy - angina
sharp or stabbing - pericarditis or pleurisy
burning - acid reflux

35
Q

onset of pain

A

predictable with exertion - angina

not exertional - all others

36
Q

relieving factors

A

relived by rest and by nitrates - angina

37
Q

positional pain

A

not positional - angina
worse supine - pericarditis
onset may be when supine - relux

38
Q

affect with respiration

A

not affected by respiration - angina or relfux

worse with respiration - pericardial or pleural rub

39
Q

elements of history which discriminate for MI over angina

A 
onset at rest 
severe pain 
sweating 
anxiety 
no relief with nitrates 
associated synmptoms - nausea and vomiting
40
Q

factors discriminating for aortic dissection over myocardial infarction

A

radation to the back
instantaneous onset
tearing quality of pain
history of marfans disease or ehlers - danlos syndrome

41
Q

factors discriminating for chest wall pain over myocardial ischameia

A 
positional 
worse at rest 
prolonged
localised
chest wall tenderness
42
Q

some questions to ask with chest discomfort suspected angina

A
  1. sharp, dull, heavy or tight
  2. does it come on with physical exercise
  3. how loong does it last
  4. where do you feel it
  5. does it make you stop or slow down
  6. does it go away quickly when you stop exercising
  7. does it come on at rest
  8. have you had angina before and does this feel the same
43
Q

unstable angina

A

change in the previous pattern of onset of previously stable angina

44
Q

angina should be relieved by

A

rest or GTN spray

45
Q

duration of pain

A

<30 mins - angina
>30 mins - acute coronary syndrome
> many days - neither

46
Q

pleuritic pain

A

worse on inspiration
may be due to pleurisy or pericarditis
not brought on by exertion
relived by sitting up and leaning forward
caused by movement of inflamed pleural or pericardial surfaces

47
Q

pleurisy

A

may occur because of inflmmation of the pleura as a primary problem (viral infection) or secondary to pneumonia or pulmonary embolism

48
Q

factors favouring massive pumonary embolism

A

collapse, dyspnoea, cyanosis

often pleuritic

examinations (6 decks)

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