Chest Pain Flashcards
1
Q
What are 5 causes of chest pain with characteristic presentations?
A
- myocardial ischaemia
- aortic dissection
- pleural disease
- oesophageal disease
- MSK disease (eg. costochodritis)
2
Q
What is myocardial ischaemia?
A
reduced blood flow to heart, preventing the heart muscle from receiving enough oxygen
3
Q
What is aortic dissection?
A
- a serious condition in which a tear occurs in the inner layer of aorta.
- Blood rushes through the tear, causing the inner and middle layers of the aorta to split (dissect)
- If the blood goes through the outside aortic wall, aortic dissection is often deadly.
4
Q
What are the characteristic presentations of myocardial ischaemia?
A
- crushing, gripping or heavy pain, focussed centrally on chest
- can radiate to neck, shoulder or jaw (classically L sided radiation)
- assoc. w. paraesthesia / heaviness in one or both arms
- assoc. w. dyspnoea, nausea and sweating
- comes on over minutes
5
Q
What are the characteristic presentations of aortic dissection?
A
- severe, central chest pain, radiating to back and down arms
- patients may be shocked and have neurological symptoms secondary to loss of blood supply to spinal cord
- may be signs of distal ischaemia or absent peripheral pulses
- comes on over seconds
6
Q
What are the characteristic presentations of pleural disease?
A
- localised sharp pain, worse on deep breathing and coughing
- assoc. w costo-chondral tenderness
- pain in shoulder tip is suggestive of diaphragmatic pleural irritation
7
Q
What are the characteristic presentations of oesophageal disease?
A
- retrosternal chest pain, can be difficult to seperate from cardiac pain
- worse on bending over or lying down, relieved by antiacids
8
Q
What is MSK disease (eg. costochondritis)
A
- can cause very severe pain, importantly assoc. w local tenderness
- worse with certain movements, often a history of trauam or causative event
