Chest Pain Flashcards
Symptoms of PE
Pleuritic chest pain worse on inspiration
Breathlessness
Haemoptysis
Signs of saddle or large PE
Dizziness
Syncope / pre-syncope
Haemodynamic instability
PE on examination
Tachycardia
Tachypnoea
Hypoxia
Clear chest
Sudden onset SOB and pleuritic chest pain, haemoptysis, raised RR
PE
Investigations for PE
Wells score
D-Dimer
FBC
U&Es
LFTs
CRP
ABG
ECG
What will a CXR show in PE?
Normal, small wedge, small effusions
ECG findings in PE
Sinus tach
If large, right heart strain (S1 Q3 T3) RBBB R axis deviation
When don’t you do a CTPA?
Pregnancy - consider V/Q scan
What wells score makes u do CTPA
Over 4
What do u do wells score 3?
Do D-dimer
How do you manage a normal PE?
Oxygen
Anaelgesia
Anticoagulation - LMWH or apixaban
How do you manage massive PE
Consider thrombolysis
What is Virchows triad?
Hypercoagulability
Stasis blood flow
Endothelial injury
Is pneumothorax type 1 or 2 respiratory failure
Type 1
Symptoms of pleurisy
Sudden onset
Sharp pain
Worse on inspiration
Recent viral symptoms
Lung sounds in pleurisy
Pleural rub
Is it a PE or pleurisy?
Pleurisy - infective symptoms and pleural rub
What does CXR show in pleurisy?
Consolidation
How do you treat pneumothorax less than 2cm?
Oxygen and observe
How do you treat pneumothorax over 2cm?
Aspirate, chest drain
What is pleurisy?
Inflammation of the pleura due to viral infection
Symptoms of CAP
Fever
Rigours
Breathlessness
Cough green sputum
Chest pain
Exam findings in CAP
Increased RR
Tachycardia
Course crackles
Bronchial breathing
Investigations for CAP
FBC
U&Es
LFTs
CRP
WCC
CRP
Elevated neutrophils
Sputum cultures
ABG
CXR
What does CXR and ABG show in CAP
Type 1 resp failure
Consolidation
What does CURB 65 mean?
For predicting mortality in CAP
Symptoms of lung cancer
Breathlessness
Chest pain
Haemoptysis
Weight loss
Cough
Signs of lung cancer on exam
Clubbing
Hypoxia
Cachectic
Lobar collapse
Pleural effusion
Pancoast tumour
Horner syndrome
Weakness and muscle wasting in the hand of affected side
Horner syndrome
Flushing on one side of face
Not sweating on affected side of face
Constricted pupil and droopy eyelid on affected side
Risk factors for MI
HTN, diabetes, previous IHD, high cholesterol, smoking
Bloods to do in MI
FBC
Lipids
U&Es
HbA1c
LFTs
Troponins
Immediate drug treatment for MI
Aspirin 300mg
Clopidogrel 300mg or Tecligor
Ongoing drug treatment following MI
Beta blockers, CCBs, ACEi, statin, aspirin or Clopidogrel
Why take beta blockers or CCBs after MI?
Reduce cardiac work
Why take ACEi or CCB after MI?
Reduce blood pressure
Drug treatment for angina
GTN
Opioids
Beta blockers
CCBs
ACEi
Statins
Symptoms of aortic dissection
Sudden onset severe central ripping chest pain
Radiates through to back and neck
Rapid collapse
Examination in aortic dissection
Hypotension
Hypovolaemic shock
Different BP in each arm
New early diastolic murmur
Wide pulse pressure
What do we do about aortic dissection?
Group and save, crossmatch
Fluid resus
Surgery
Symptoms of pericarditis
Sharp anterior chest pain
Acute onset, often following viral illness
Can have fever or viral symptoms
Quality of pain in pericarditis
Sharp
Anterior
Relieved by leaning forwards
Worse on deep inspiration or lying down
Symptoms of cardiac tamponade
Reduced cardiac output
Low blood pressure
Raised JVP
muffled heart sounds
Can cardiac tamponade occurs in pericarditis?
Yes
Treatment for pericarditis
Pericardiocentesis
How to diagnose cardiac tamponade
Echo
ECG changes with pericarditis
Widespread saddle ST elevation, later T wave inversion
What is Dressler’s syndrome
When you get a pericarditis following an MI
How do you know if it’s an MI or pericarditis?
Sometimes viral stuff in pericarditis
Pericarditis pain relieved leaning forwards, worse lying down or coughing/breathing deeply
Cancer Red flags with GORD
Dysphasia
Upper abdo pain
Dyspepsia
Haematemesis
Consequences of prolonged GORD
Barrett’s oesophagus
Oesophageal cancer
Oesophagitis
Ulcers
Structures
How do you know if the chest pain in MSK?
Anywhere
Worse with movement
Worse breathing in
Clear cause or trigger
Tender to touch