Chest pain Flashcards
Sources of chest pain (8)
Cardiac
Pericardial
Oesophageal
Pleural
Vascular
Musculoskeletal
Neurological
Psychological
6 causes of acute life threatening chest pain
MI
Massive PE
Ruptured aortic aneurysm.
Pericarditis
Acute pneumothorax
Ruptured oesophagus
Angina pectoris
Caused by myocardial ischaemia
Can lead to myocardial infarction.
Strangling-like pain.
Differences between MI and angina
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.
Cardiac pain
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
Chest pain history (7)
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.
Stable angina features (5)
Predictable
Exacerbates on exercise
Worse in cold or windy weather.
Induced by stress
Relieved by nitrates
Basic treatment of MI
- Aspirin
- GTN spray
- Diamorphine
- O2 if stats are <96%
Pericardial pain
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.
Causes of pericarditis
Viral- can be complication of flu. Examples: Coxsackie Mumps Herpes HIV
Can occur after an MI
Pleuritic chest pain
Usually one side
Worse on inspiration
Type: severe sharp, stabbing pain
Can be accompanied with dyspnoea and haemoptysis
Differential diagnosis of pleuritic pain
Pneumonia
PE
Pneumothorax
Malignancy
Dissecting aortic anuerysm
A vascular cause of chest pain.
Very sudden onset of pain, compared to MI.
Tearing pain
Less urgent causes of chest pain
Gastro-oesophageal reflux
MSK pain
Trauma
Malignancy
Psychological
Most common causes of chest pain in medical ward
Pneumonia
MI
PE
GORD
Gastroesophageal reflux disease
Similar to cardiac pain
Burning discomfort
Acid/ bitter taste in mouth
Pain induced by bending.
Relieved by antacid
Dermatological cause of MSK pain
Shingles
Neurological cause of MSK pain
Nerve root compression due to:
Collapsed vertebrae
Bone metastasis
MSK chest pain
Pain from the chest wall induced or relieved by postural change.
Very localised and intensified by pressure
Tietze’s syndrome
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.
