Chest pain

Question 1

Describe the characteristic, and contrasting, features of chest pain resulting from myocardial ischaemia

Answer 1

Pain similar to angina (retrosternal, crushing, worse with exertion/cold/after food) but more severe and not relieved by GTN spray. Associated with nausea, sweating and vomiting. Patients may experience “angor animi”, a feeling of impending doom.

Question 2

Describe the characteristic, and contrasting, features of chest pain resulting from aortic dissection

Answer 2

Severe tearing pain, felt between shoulder blades. Patient commonly hypertensive or Marfan-oid. Persistent, most severe at onset.

Question 3

Describe the characteristic, and contrasting, features of chest pain resulting from pleural and respiratory disease

Answer 3

Sharp pain, worse on inspiration and coughing. Not relieved by GTN. Not central, may be one sided, no radiation. Often associated with breathlessness or cyanos

Question 4

Describe the characteristic, and contrasting, features of chest pain resulting from gastro-oesophageal disease

Answer 4

GORD will cause a typical “heartburn”, a retrosternal burning sensation after food, relieved by antacids. Oesophageal spasm may be mistaken for MI/angina. It will be relieved with GTN after ~20 minutes, later than the 2 minute relief in angina. The pain will be severe, retrosternal and burning. Often associated with a history of dyspepsia or dysphagia

Question 5

Describe the characteristic, and contrasting, features of chest pain resulting from musculo-skeletal disease

Answer 5

Localised to one location on the chest, tender to palpitation, more sensitive on when moving and respiring.