Chest Pain

Question 1

What are some cardiac causes of chest pain and how may they present?

Answer 1

• Myocardial Ischaemia. dull, centrally located, retrosternal pain. Intensity depends on degree of ischaemia. Pain may radiate.
• Pericarditis. Inflammation the pericardial sac that causes sharp, central, position dependent pain.

Question 2

What are some GI causes of chest pain and how may they present

Answer 2

• peptic ulcers

- reflux

Question 3

What are some respiratory causes of chest pain?

Answer 3

• pulmonary embolism (sharp and well localised)

- pneumonia (on the side, accompanied by fever, cough and breathlessness).

Question 4

What are some muscoskeletal causes of chest pain?

Answer 4

• Rib fracture
• Costal chondrites
• well localised, sharp, tender to palpate, worse with movement

Question 5

Why may pleural pain be confused with ischaemic chest pain?

Answer 5

-both types worsened with exertion
-lung and heart pain can’t dull and poorly localised as pain isn’t associated with any specific spinal nerves just diffuse autonomic nerves
-

Question 6

How may pericarditis affect ECG?

Answer 6

• ST Elevation

- saddle shaped appearance

Question 7

What is stable angina?

Answer 7

• Stable atherosclerotic plaque
• ischaemia only occurs when metabolic demands of cardiac muscle are greater than what can be delivered via coronary arteries

Question 8

What is acute coronary syndrome?

Answer 8

Acute myocardial ischaemia caused by atherosclerotic coronary artery disease

– Atheromatous plaques rupture with thrombus formation causing an acute increased occlusion (in an already partially occluded lumen) leading to
ischaemia

-Ranges from Unstable angina to STEMI

Question 9

How does Unstable angina typically present?

Answer 9

-similar to stable angina except:

• pain occurs at rest
• pain may be more intense
• pain may last longer
• risk of deteriorating further (NSTEMI or STEMI)