Chest Pain

Question 1

Chest Pain

Aortic Dissection

Answer 1

• Tearing intrascapular pain
• Dissection spread distally or proximally
• Diagnosis by chest X ray, widened mediasternum
• Proximal type A lesions - Surgical
• Distal type B lesions - Non operatively

Question 2

Chest Pain

Pulmonary embolism

Answer 2

• Sudden onset pain
• DVT
• S waves in lead I, Q waves in lead III, Inverted T waves in lead III
• Anti cog treatment

Question 3

Chest Pain

Myocardial Infarction

Answer 3

• Sudden onset central crushing pain
• Radiate to neck and down left arm
• Diagnosis through ECG changes
• Inferior/Anterior infarcts (II, III and AVF - inferior) (V1-V5 - anterior)
• Treatment oral antiplatlets and or thrombolysis

Question 4

Chest Pain

Perforated Peptic Ulcer

Answer 4

• Sudden onset of epigastric abdo pain, followed by generalised abdo pain
• gastric ulcer worse on eating
• Diagnosis erect chest X ray, may show small amount of intra abdo pain
• Treatment with laporotomy/partial gastrectomy

Question 5

Chest Pain

Boorhaaves Syndrome

Answer 5

• Spontaneous rupture of oesophagus after repeated vomitting
• sudden onset of severe chest pain on left side
• severe sepsis
• Diagnosis is CT contrast swallow
• Treatment thoracotomy and lavage if < 12 hours
• >12 hours insertion of T tube, creat controlled fistula
• > 12 hours high mortality rate