Chest Pain Flashcards
Pathologies of what anatomically could cause chest pain (8)
heart, aorta, lungs, pulmonary vessels, oesophagus, stomach (upper areas), thoracic nerves, or thoracic muscles.
DDx of chest pain (17)
Acute coronary syndrome (MI and unstable angina)
Stable angina
Pulmonary embolism (PE)
Pleurisy (secondary to infection)
Musculoskeletal (muscle strain and infection)
Oesophagitis (secondary to gastro-oesophageal reflux disease or hiatus hernia)
Anxiety
Oesophageal spasm
Peptic ulcer disease Pneumothorax
Myopericarditis
Aortic dissection
Aortic aneurysm
Coronary spasm (e.g. secondary to cocaine) Boerhaave’s perforation of the oesophagus
Cholecystitis
Pancreatitis
Which can cause musculoskeletal chest pain (4)
Cocksackie B (Bornholm’s disease)
Idiopathic costochondritis
Muscle strain
Varicella zoster infection
What would a younger patient presenting with chest pain indicate against? (5)
- Acute coronary syndrome
- Stable angina
- Myopericarditis (usually post-infarction)
- Aortic dissection
- Aortic aneurysm
What is a younger patient on the oral contraceptive pill presenting with chest pain most likely to be sugaring from? (3)
PE (the combined oral contraceptive pill is thrombogenic)
• Pneumothorax (especially if tall and thin)
• Cocaine-induced coronary spasm (still rare, but particularly unusual in the elderly!)
What groups of signs should you look for in someone presenting with features of ACS
Hypercholesterolaemia
Systemic atherosclerotic valvular disease
Anaemia
Arrhythmias
What should you ask about in the Hx of someone with suspected ACS
Smoking Hypertension Hypercholesterolaemia Diabetes FHx
How does a pneumothorax present
History of sudden-onset pleuritic chest pain with breathlessness – but
beware, it may present as painless breathlessness.
How does aortic dissection present
− History of sudden-onset tearing chest pain radiating to the back.
How does ACS present
− History of sudden-onset, central crushing chest pain radiating to either/both arms and neck, especially in someone with a previous history of angina on exertion or MI and/or cardiovascular risk factors (smoking, hyper- tension, hypercholesterolaemia, diabetes, family history).
What 5 diagnoses should you immediately rule out in chest pain?
- Acute coronary syndrome (unstable angina, or myocardial infarction (MI))
- Aortic dissection
- Pneumothorax
- PE
- Boerhaave’s perforation
What Ix in someone suspected of MI (11)
ECG Troponin Serum cholesterol (will drop 1 day after infarct so need ASAP) FBC U&E's and especially K+ as it can cause arrhythmias CRP ESR WCC Cap glucose CXR D-dimer (not standard but to exclude PE)
What is the Mx for ACS?
MONABASH Morphine (and metaclopramide - an anti-emetic) Oxygen Nitrates (GTN) Antiplatelets (aspirin, clopidogrel, glycoprotein IIb/IIIa antagonists) Beta blockers ACEi Statins Heparin
STEMI patients should also receive primary angioplasty or thrombolysis within 12 hours of onset of the pain
What is used to assess NSTEMI patients for early angioplasty?
TIMI score
Lifestyle advice for someone with IHD (4)
smoking cessation, low-salt diet, exercise, and weight loss.