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CI1 > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

What are the causes of chest pain?

A
  • Cardiac (MI, angina, pericarditis)
  • Vascular (aortic dissection)
  • Respiratory (PE, pneumothorax, pleurisy)
  • GI (Reflux, oesophageal tear)
  • Neurological (herpes zoster)
  • Musculoskeletal
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2
Q

What should be included in the history for a patient with chest pain?

A
  • Presenting complaint
  • Past medical history
  • Drug history
  • Family history
  • Social history
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3
Q

What should the past medical history include?

A
  • History of CHD
  • Recent operations/procedures (e.g. cardio Sx)
  • History of peptic ulcer disease or use of NSAID
  • Recent illness - Pericarditis might be proceeded by prodromal viral illness
  • Long periods of inactivity - May precede PE
  • Hypertension
  • Diabetes, high cholesterol
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4
Q

What should the drug, family & social history include?

A
  • Risk factors for CHD (age, ethnicity, family Hx, smoking, obesity, physical inactivity, depression, stress)
  • Heavy alcohol use (risk factor for gastritis & peptic ulcer disease)
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5
Q

What questions specifically regarding the chest pain should be asked?

A
  • Duration of pain
  • Site of pain
  • Intensity of pain (VAS)
  • Quality of pain (burning, dull etc)
  • Continuous/intermittent
  • Radiation of pain
  • Experienced before
  • Aggravating/easing factors
  • Other symptoms at same time (nausea, SOB, sweating)
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6
Q

What does CVD include?

A

Heart, stroke and blood vessel diseases

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7
Q

What are the warning signs of a heart attack?

A
  • Pain, pressure, heaviness or tightness in jaw, neck, shoulders, chest, back, arms
  • Nausea
  • Dizziness
  • Cold sweat
  • SOB
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8
Q

How are the heart attack signs different for women?

A

More than 40% don’t experience chest pain

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9
Q

What are the pain characteristics of myocardial ischaemia?

A 
Quality: Crushing, tight
Site: Central anterior chest
Radiation: Throat, jaw, arms
Agg: Exertion, anxiety, cold
Eas: Rest, glyceryl trinitrate
Associated: Sweaty, SOB, nausea, shocked
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10
Q

What is aortic dissection?

A
  • Damage to layers of aorta
  • High intraluminal pressure causes a tear
  • Blood enters & dissects the luminal plane creating a false lumen
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11
Q

What is the primary risk factor for aortic dissection?

A

Hypertension

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12
Q

What are the signs of aortic dissection?

A
  • Shock, cyanosis, sweating
  • BP & pulses differ between extremities
  • Aortic regurgitation, cardiac tamponade, cardiac failure
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13
Q

What is circulatory shock?

A

CV dysfunction, inadequate O2 being delivered to tissues

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14
Q

What are the types of causes of circulatory shock?

A
  • Hypovolaemic
  • Septic
  • Cardiogenic
  • Anaphylactic
  • Spinal
  • Neurogenic
  • Toxic
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15
Q

What are the symptoms of aortic dissection?

A
  • Central tearing chest pain radiating to back

- Further complications arise if dissection affects beaches of aorta (MI, hemiplegia, paraplegia, abdominal pain)

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16
Q

What are the aortic dissection investigations?

A
  • CXR: widened mediastinum
  • ECG: ST elevation
  • CT/MRI: False lumen
  • Echo: Pericardial effusion
17
Q

What are the pain characteristics of aortic dissection?

A 
Quality: Sharp, stabbing, tearing
Site: Retrosternal, interscapular
Radiation: Usually nil
Agg/Eas: Nil (constant)
Associated: Unequal pulse & BP, aortic regurgitant murmur
18
Q

What are the pain characteristics of pericarditis?

A 
Quality: Sharp, (may be crushing)
Site: Central anterior
Radiation: Usually nil
Agg: Lying back
Eas: Sitting forward
Associated: Fever, recent viral illness
19
Q

What are some of the causes of pericarditis?

A
  • Viral illness
  • Injury to the chest
  • Cardiac surgery
  • Heart attack
20
Q

What are some of the respiratory causes of chest pain?

A
  • Pleurisy
  • PE
  • Pneumothorax
  • Tumours
21
Q

What features are associated with respiratory causes of chest pain?

A
  • Cough (may be productive)
  • Haemoptysis
  • Shock (PE)
  • Dynpnoea
22
Q

What are the causes of dyspnoea?

A
  • Cardiac failure
  • Coronary artery disease
  • Pulmonary embolism
  • Pneumothorax
  • COPD, asthma
23
Q

What chronic dyspnoea signs are associated with heart failure?

A
  • Orthopnoea

- Paroxysmal nocturnal dyspnoea

24
Q

What acute dyspnoea signs are associated with heart failure?

A
  • Crackles/wheezes
  • Pink, frothy sputum
  • APO
  • Pneumothorax
  • PE
25
Q

What are the outcomes of right and left sided heart failure?

A

Right: Peripheral oedema
Left: Pulmonary oedema

26
Q

What are the pain characteristics of GI causes of chest pain?

A

Quality: Burning
Site: Central
Radiation: To throat
Agg: Food (oesophageal pain & cholecystits)
Eas: Food & antacids (peptic uler pain)
Associated: Excessive wind

27
Q

What are the likely causes of musculoskeletal chest pain?

A
  • Rib trauma (fracture, contusion)
  • Referred pain from TS
  • Sternoclavicular joint disorders
28
Q

What are the less likely causes of musculoskeletal chest pain?

A
  • Costochondritis
  • Sternocostal joint sprain
  • Intercostal muscle sprain
  • Rib stress fracture
  • Fractured sternum
29
Q

What are the NTBM causes of musculoskeletal chest pain?

A
  • Cardiac causes
  • Peptic ulceration
  • GI reflux
  • Pneumothorax
  • PE
  • Herpes zoster
30
Q

What is herpes zoster?

A
  • Reactivation of varicella zoster virus (chicken pox) in sensory ganglion
  • Extremely painful
  • Symptoms: Headache, fever, malaise, followed by itching, tingling, pain with dermotomal distribution, rash
31
Q

What factors differentiate chest pain referred from TS, rather than myocardial infarction?

A
  • Age
  • History of injury
  • Site/radiation
  • Type of pain
  • Agg/eas factors
  • Associations
32
Q

What are the investigations for suspected heart attack?

A
  • ECG (first)
  • PCI
  • CXR
  • Biochemical markers
  • Oximetry & ABGs
  • Echocardiography, CT, MRI, CTPA, V/Q scan
  • Exercise test
33
Q

What are the management options for coronary artery disease?

A
  • CABG

- PCI (percutaneous coronary intervention): Wire inserted into artery, balloon blown up to push blockage aside

CI1 (21 decks)

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