Chest pain

Question 1

Sources of chest pain (8)

Answer 1

Cardiac

Pericardial

Oesophageal

Pleural

Vascular

Musculoskeletal

Neurological

Psychological

Question 2

6 causes of acute life threatening chest pain

Answer 2

MI

Massive PE

Ruptured aortic aneurysm.

Pericarditis

Acute pneumothorax

Ruptured oesophagus

Question 3

Angina pectoris

Answer 3

Caused by myocardial ischaemia

Can lead to myocardial infarction.

Strangling-like pain.

Question 4

Differences between MI and angina

Answer 4

Severity: MI more severe than angina

Length: MI lasts longer, for hours.

Nitrates: MI is not relieved by nitrates

Cause: No precipitating cause in MI/

Extra symptoms: MI accompanied by pallow, sweating and vomiting.

Question 5

Cardiac pain

Answer 5

Main area:
Front of chest
Mid/upper sternum

Radiation:
Left arm/ both arms
Around chest
Into the jaw.

Description:
Tight, heavy, crushing etc

Atypical- women, diabetics

Question 6

Chest pain history (7)

Answer 6

Its onset- when it happened.

Site: area and radiation.

Quality and intensity: description of pain

Pattern and duration:
Length and recurrence of pain.

Exacerbating factors: Eating, exercise etc.

Relieving factors: medication, position

Associated symptoms: i.e sweating, weight loss, vomiting.

Question 7

Stable angina features (5)

Answer 7

Predictable

Exacerbates on exercise

Worse in cold or windy weather.

Induced by stress

Relieved by nitrates

Question 8

Basic treatment of MI

Answer 8

1. Aspirin
2. GTN spray
3. Diamorphine
4. O2 if stats are <96%

Question 9

Pericardial pain

Answer 9

Type of mediastinal pain

Referred pain can be felt at shoulder and back

Made worse by breathing, coughing and sneezing

Relieved by sitting forward- affected by posture.

Question 10

Causes of pericarditis

Answer 10

Viral- can be complication of flu.
Examples:
Coxsackie
Mumps
Herpes
HIV

Can occur after an MI

Question 11

Pleuritic chest pain

Answer 11

Usually one side

Worse on inspiration

Type: severe sharp, stabbing pain

Can be accompanied with dyspnoea and haemoptysis

Question 12

Differential diagnosis of pleuritic pain

Answer 12

Pneumonia

PE

Pneumothorax

Malignancy

Question 13

Dissecting aortic anuerysm

Answer 13

A vascular cause of chest pain.

Very sudden onset of pain, compared to MI.

Tearing pain

Question 14

Less urgent causes of chest pain

Answer 14

Gastro-oesophageal reflux

MSK pain

Trauma

Malignancy

Psychological

Question 15

Most common causes of chest pain in medical ward

Answer 15

Pneumonia

MI

PE

Question 16

GORD

Answer 16

Gastroesophageal reflux disease

Similar to cardiac pain

Burning discomfort

Acid/ bitter taste in mouth

Pain induced by bending.

Relieved by antacid

Question 17

Dermatological cause of MSK pain

Answer 17

Shingles

Question 18

Neurological cause of MSK pain

Answer 18

Nerve root compression due to:
Collapsed vertebrae
Bone metastasis

Question 19

MSK chest pain

Answer 19

Pain from the chest wall induced or relieved by postural change.

Very localised and intensified by pressure

Question 20

Tietze’s syndrome

Answer 20

Benign inflammation of one or more costal cartilages.

Cause of MSK chest pain

More common in males, 20-30 yrs old

Pain exacerbated by coughing, sneezing and movement.