Chest Pain

Question 1

Potentially life-threatening conditions, with central chest pain

Answer 1

Coronary artery disease (MI, acute coronary syndrome)

Massive pulmonary embolism

Thoracic, aortic dissection

Pneumothorax

Oesophageal rupture

Question 2

Conditions causing central chest pain, but not immediately life-threatening

Answer 2

Pericarditis
Gerd
muscular / skeletal pain
Anxiety

Question 3

Causes of pleuritic chest pain

Answer 3

Pericarditis
Pulmonary embolism
Pneumothorax
Pneumonia
Empyema
Viral pleuritis
Malignant involvement of chest wall
Rib, trauma fracture, or metastasis
Inflammatory pruritus (SLE, RA)

Question 4

What investigation should you do as soon as a patient presents with chest pain

Answer 4

ECG

Question 5

if a patient presents with a severe tearing central chest pain, radiating to the interscapular area with an asymmetric blood pressure on examination what is your main differential?

Answer 5

Aortic dissection

Question 6

when there is central, severe chest pain with vomiting, what is one of the main differential?

Answer 6

Esophageal rupture

Question 7

If a patient presents with central chest pain and sign of crepitation on examination, what is one of the main differential

Answer 7

Pulmonary edema

Question 8

If a patient presents with central chest pain , hyperresonance on percussion and tracheal deviation on examination, what is your main differential?

Answer 8

Pneumothorax

Question 9

Type of chest pain in pericarditis

Answer 9

Classic central pain, relieved by sitting forward or central pleuritic

Question 10

If a patient presents with a central chest pain, radiating to the left arm with a feeling of illness, nausea, sweating, and a relationship with exercise , what is your main differential?

Answer 10

Ischemic cardiac disease

Question 11

If a patient presents with insidious, intractable, chest wall pain , what should come to your mind

Answer 11

Malignancy or asbestos

Question 12

Investigations

Answer 12

ECG ( mi , pericarditis pulmonary embolism)
Chest x-ray (pneumothorax , pneumomediastinum from eosephageal rupture, Heart failure, pneumonia, rib fracture, pleural effusion)
CT scan (thoracic aorta dissection)
cardiac troponin ( acute coronary artery pathology)
CT pulmonary angiogram/ ventilation perfusion scan ( PE)
Echocardiogram (pulmonary embolus with shock )

Question 13

what is pleuritic chest pain?

Answer 13

Sharp, stabbing, chest pain
n made worse by deep breathing, or coughing, when pleura is inflamed