Chest Pain

Question 1

Defintion of chest pain

Answer 1

Pain in the thorax which can be classified into cardiac ischemic pain which is dull and poorly localised or non-cardiac pleuritic pain which is sharp, non-central and well localised

Question 2

Risk factors for ACS (5)

Answer 2

smoking,
HTN,
hyperlipidaemia,
diabetes
obesity

Question 3

Presentation of ACS’s - 6

Answer 3

dull,
tight or crushing in quality, poorly localised,
epigastric,
radiates to shoulders and neck,
SOB.
Angina is worsened on exertion.

Question 4

Prx of aortic dissection

Answer 4

tearing quality pain

Question 5

Prx of MSK/Pleural problems - 2

Answer 5

sharp
worse on inspiration

Question 6

Prx of pericarditis

Answer 6

hear a pleural rub on auscultation

Question 7

Prx of GORD

Answer 7

burning quality pain

Question 8

Investigations of chest pain (3)

Answer 8

ECG

CXR (excludes pneumonia, rib fracture, aortic aneurysm), Abdo ultrasound (excludes gallstones)

FBC, Troponin, serum amylase, WCC (to exclude pneumonia)

Question 9

Management of pts requiring admission (2) and when would they need admission (6)

Answer 9

Admit people with :
high resp rate
tachycardia
low BP
low O2
raised temps
have signs very indicative of acute coronary syndromes or pulmonary oedema

Manage patients whilst waiting for admission by:
sitting the person up
do not routinely administer O2

Question 10

Management of pts not requiring admission for chest pain

Answer 10

Referred for urgent same-day assessment if they have suspected ACS with chest pain in the last 12 hours, or referred within 2 weeks if suspected ACS within 72 hours.

Stable angina can be managed in primary care.

Question 11

Differentials

Answer 11

Angina and ACS

Pericarditis

Pneumonia, PE, Pneumothorax

GORD

Cholecystitis or biliary colic

Acute pancreatitis

Trauma, rib fracture, shingles

Aortic dissection

Anxiety and depression