Chest Pain

Question 1

Name all questions in presenting complaint? (9)

Answer 1

• “Is there any history of MI/stroke (before the age of 65) in your family?”
• “Can you point to where the pain is worst?”
• “Can you describe the pain?”
• “Does the pain radiate anywhere?”
• “Have you got any nausea, sweating, anxiety, cough or dyspnoea?”
• “Is the pain constant or does it come and go?”
• “Does anything make the pain better or worse?”
• “Out of 10, how bad is the pain?”
• “Have you ever had anything like this before?”
• “Have you noticed any leg or ankle swelling?”

Question 2

Cardiac pain is usually where and like what?

Answer 2

Central and crushing

Question 3

What other pains can be central?

Answer 3

GOR, aortic dissection, pericarditis

Question 4

Chest wall pain is usually…?

Answer 4

Well localised

Question 5

Pain of a pneuothorax is usually…?

Answer 5

Well localised

Question 6

How would the patient describe angina?

Answer 6

patient may feel ‘discomfort’ rather than pain, describing it as crushing, dull or aching. They may experience heaviness or paraesthesia in one or both arms

Question 7

How may the patient describe an MI?

Answer 7

Similar to angina but more severe

Question 8

How would pleuritic pain, chest wall pain and pain of a pneumothorax be described?

Answer 8

Characteristically sharp and severe

Question 9

A dissecting aortic aneurysm is described as what?

Answer 9

‘Tearing’

Question 10

A massive PE can cause what types of pain?

Answer 10

An angina type pain or a pleuritic pain

Question 11

Where does cardiac pain typically radiate to?

Answer 11

Left arm, neck and/or jaw and occasionally into the teeth, back or abdomen

Question 12

Where does the pain of a dissecting aortic aneurysm radiate to?

Answer 12

Back

Question 13

Diseases of cervical or upper thoracic spine cause pain that radiates from…to…?

Answer 13

From the back to the front of the chest

Question 14

What associated symptoms will an MI produce?

Answer 14

Dyspnoea, sweating, anxiety, nausea and faintness

Question 15

Associated symptoms of a chest infection along with pleuritic pain?

Answer 15

Productive cough and pyrexia

Question 16

PE pain is associated with…?

Answer 16

Dyspnoea and cough/haemoptysis

Question 17

Pneumothorax pain associated with…?

Answer 17

Dyspnoea

Question 18

Oseophageal spasm will have pain associated with…?

Answer 18

Dysphagia

Question 19

How is stable angina relieved?

Answer 19

Rest/nitrates. Brought on by exertion

Question 20

How is pleuritic pain brought on/relieved?

Answer 20

Brought on by inspiration and relieved by sitting up and leaning forwards

Question 21

Chest wall pain is made worse by…?

Answer 21

Respiration or movement of the shoulders

Question 22

Oesophageal spasm may be precipitated by…? and relieved by…?

Answer 22

Precipitated by drinking hot or cold fluids and is relieved by rest

Question 23

Unilateral leg swelling suggests what?

Answer 23

May be a DVT and PE

Question 24

Bilateral leg swelling worse at night suggests what?

Answer 24

Heart failure

Question 25

What should you ask specifically about in PMH/FH?

Answer 25

-	Ask specifically about risk factors for an MI.
•	Family history
•	Hypertension
•	Diabetes mellitus
•	Smoking
•	Hypercholesterolaemia

• “Have you ever had a DVT/PE? Any recent surgery? Immobility? Malignancy? Pregnancy?”

Question 26

What should you ask about in drug history?

Answer 26

OCP - increases risk of DVT/PE.

If patient has had MI, ask if they were given streptokinase as it shouldn’t be used twice