Chest pain Flashcards
Likelihood of a symptom leading to a consultation
Reduced energy 456:1
Headache 184:1
Disturbance of gastric function 109:1
Backache 52:1
Pain in chest 14:1
Chest pain is common
5% population experience chest pain in any two week period
2% patients in GP have chest pain as new symptom
30% hospital medical admissions have chest pain
Sources of chest pain
Cardiac Pericardial Oesophageal Pleural Vascular Musculoskeletal Neurological Psychological
Acute life threatening causes of chest pain
Myocardial ischeamia/ infarction
Massive PE
Ruptured aortic aneurysm
Pericarditis
Acute pneumothorax
Ruptured oesophagus
Angina pectoris
Medical term for chest pain
Similarities of MI and angina
Pain distribution
Differences of MI and angina
Severity
Frightening
Lasts hours
Not relieved by nitrates
Not precipitating cause
Accompanied by pallor, sweating, vomiting
Cardiac pain location
Front of chest, mid or upper sternum
Radiates to left arm, both arms, round the chest or into the jaw
Description of chest pain
Tight, heavy, constricting, crushing, numbing or burning
Atypical chest pain
e.g. in women and diabetes
Chest pain history
Onset
Site of pain
Quality and intensity
Pattern and duration
Exacerbating factors
Associated symptoms
Relieving factors
Check list for stable angina
- predictable
- related to exercise
- worse in cold or windy weather
- induced by stress
- relieved by nitrates
Suspected MI treatment (community)
Aspirin
GTN spray
Diamorphine
O2 (if sats <96%)
Pericardial pain
Mediastinal pain
May be referred to shoulder and back
Made worse by breathing, coughing and sneezing
Influenced by posture, typically relieved by sitting forward
Causes of pericarditis
Viral infection
- in context of ‘flue like’ illness
- coxsackie virus, mumps, herpes, HIV
Post MI
Pleuritic pain
Usually one sided
Worse on inspiration
Sharp, stabbing, knife like
Severe
Dyspnoea/ haemoptysis
Vascular causes of chest pain
Dissecting aortic aneurysm
Dissecting aortic aneurysm
Difficult to diagnose
Pain different to MI
- more sudden onset
- described as tearing
- moves from from to back as dissection extends
Less urgent causes of chest pain
Gastro- oesophageal reflux disease
Musculoskeletal pain
Trauma
Malignancy
Psychological
Commonest causes of chest pain (GP)
Musculoskeletal
Angina
Oesophageal reflux
Anxiety
Commonest causes of chest pain (medical ward)
Pneumonia
Myocardial infarction
Pulmonary embolism
Gastro-oesophageal reflux disease
Common
Not dissimilar to cardiac pain- often suffer from both
Burning discomfort
Induced by bending
Acid, bitter taste in mouth
Relieving GORD
Antacid and sometimes nitrate
Improved by raising head of bed and stopping smoking
Musculoskeletal chest pain
Induced or relieved by postural change
Highly localised
Reproduced by pressure
Tietze’s syndrome
Tietze’s syndrome
M>F, 20-30 years old
Pain localised to costal cartilage
Exacerbated by coughing, sneezing, motion
Dermatological/ neurological causes
Shingles
Nerve root compression
- collapsed vertebrae
- bone metastasis
- abscess
