Chest Pain

Question 1

Constant crushing/heavy/ache-like, onset at rest. May radiate into the arms/jawline/neck/back. Associated SOB, nausea/vomiting, diaphoresis, pale or clammy skin.

Answer 1

Acute Coronary Syndrome/MI/Unstable Angina

Question 2

Crushing/heavy/ache-like, onset on exertion, relieved at rest. May radiate into the arms/jawline/neck/back.

Answer 2

Stable Angina

Question 3

Constant/intermittent, may be associated with palpitations, SOB, pale clammy and sweaty skin, dizziness and syncope.

Answer 3

Cardiac Arrhythmia

Question 4

SOB worse when lying flat, fatigue/lethargy, chest pain, productive cough with blood-stained sputum, oedema in lower limbs/back or abdomen.

Answer 4

Heart Failure

Question 5

Sharp central/left-sided, may radiate into arms/neck. Worse on lying down, relieved on leaning forward. May show signs of infection.

Answer 5

Pericarditis
(Inflammation of pericardium)

Question 6

Sharp and isolated chest pain. Worse on breathing/coughing/moving, often associated with a cough and pleural friction rub.

What are causes?

Answer 6

Pleuritic Pain

Causes - chest infections, pleurisy, PE, COPD exacerbation.

Question 7

Dull-sharp pain at front of chest wall, may radiate to the back or abdomen. Worsened with coughing, breathing or activity.

Answer 7

Chostochondritis
(Inflammation where ribs meet breastbone)

Question 8

SOB, productive cough with blood-stained sputum, sharp chest pain, lethargy, fever, nausea/vomiting, abdominal pain.

Answer 8

Pneumonia

Question 9

SOB (may be sudden), sharp chest pain, productive cough with blood-stained sputum.

Answer 9

Pulmonary Embolism

Question 10

Burning epigastric abdominal pain, often radiates into chest. Worse after eating, relieved on belching.

Answer 10

Gastric Reflux

Question 11

Global chest pain, worse on moving/stretching, tender to palpate, associated with physical activity over the last 24-72 hours.

Answer 11

Muscular Pain

Question 12

ECG findings for a STEMI?

Answer 12

ST elevation/depression, pathological Q waves, symmetrical T wave inversions.

Question 13

Assessment and ECG findings for Heart Failure?

Answer 13

Auscultation suggesting consolidation - basal crackles with dull percussion.
ECG findings - ventricular hypertrophy.

Question 14

ECG findings for Pericarditis?

Answer 14

Widespread PR depression and ST elevation, reciprocal PR elevation and ST depression in aVR.

Question 15

What assessment finding can indicate Chostochondritis?

Answer 15

Tender to palpate sides of the breastbone.

Question 16

Assessment findings for Pneumonia?

Answer 16

Suggest consolidation - basal crackles, dull percussion.

Question 17

Risk factors for Pulmonary Embolism?

Answer 17

Lower limb pain/swelling (DVT), recent long haul flight, recent history of immobility, chemotherapy.

Question 18

Assessment and ECG findings for Pulmonary Embolism?

Answer 18

May be reduced air entry over area, may be sinus tachy.
S1Q3T3 = S wave in lead 1, and Q wave in lead 3 in association with T inversion in lead 3.