chest pain

Question 1

Cardiac causes of chest pain

Answer 1

angina
MI
pericarditis
aortic dissection

Question 2

pulmonary causes of chest pain

Answer 2

PE
pleurisy
pneumothorax

Question 3

Gastric causes of chest pain

Answer 3

ulcer or reflux
gallstones
pancreatitis

Question 4

what is angina

Answer 4

a pain or discomfort in the chest or adjacent areas caused by insufficient blood flow to the heart muscle

Question 5

3 Cardinal questions for angina

Answer 5

1) constricting discomfort in the front, neck, shoulders, jaw or arms
2) precipitated by physical exertion
3) relieved by rest or GTN within 5 minutes

typical angina 3 of the above
atypical angina 2 of the above

Question 6

the 6P’s of peripheral vascular disease

Answer 6

purple
painful
pulse (lost)
pins and needles
parasthesiae
paralysis

Question 7

common sites of angina radiation

Answer 7

left arm
right side
jaw
epigastrium
back

Question 8

what is unstable angina

Answer 8

angina pains which are rapidly worsening

Question 9

the Canadian cardiovascular society grading of angina

Answer 9

I) ordinary physical activity does not cause angina
II) slight limitation of ordinary activity
III) marked limitation of ordinary physical activity
IV) inability to carry on any physical activity without discomfort

Question 10

Features of chest pain suggesting MI rather than angina

Answer 10

• pain is usually more severe than angina
• more associated symptoms such as breathlessness, sweating, nausea
• usually lasts>20 mins
• usual relieving factors such as rest and GTN do not help

Question 11

features of acute pericarditis

Answer 11

sudden onset of anterior chest pain that is pleuritic and retrosternal
presence of rub on physical examination
ST elevation and PR segment depression
sharp, pleuritic pain that increases with coughing, inspiration, swallowing, lying flat

Question 12

features of aortic dissection

Answer 12

blood splits aortic media with sudden tearing chest pain which can be excruciating, often radiates to the back
branches of aorta occlude as dissection unfolds I.e. unequal BP in arms

Question 13

features of acute tamponade

Answer 13

suddenly onset
associated with chest pain and dyspnoea
becks triad
trauma/complication of catheter or pacemaker procedures

Question 14

What is Becks triad?

Answer 14

low BP, high JVP, muffled heart sounds

Question 15

Triggers of angina

Answer 15

exercise
cold
walking uphill/carrying heavy load. (increased CO and BP)
exercise following a heavy meal (postprandial angina) causing redistribution of myocardial blood flow)

Question 16

what is unstable angina

Answer 16

limiting angina of abrupt onset or increasing severity, duration or frequency.

Question 17

what is crescendo angina

Answer 17

occurs at increasing frequency at lower workloads but not at rest

Question 18

what is nocturnal or decubitus angina?

Answer 18

occurs at night or on lying flat. caused by increasing venous return or reducing efficacy of anti-angina drugs (taken in morning and wear off by night). indicates severe coronary artery disease