Chest Pain Flashcards
List the differential diagnoses of chest pain.
Musculoskeletal inflammation Acute coronary syndrome Pulmonary embolism Stable angina Pleurisy Oesophagitis Pneumothorax Peptic ulcer disease Myopericarditis Aortic dissection Boerhaave’s perforation
List three differentials for chest pain that are more likely in young patients?
PE
Pneumothorax
Cocaine-induced coronary artery spasm
What are the five fatal causes of chest pain that you must rule out when taking a history?
PE Pneumothorax ACS Aortic dissection Boerhaave’s perforation
Which signs on examination could suggest that the patient has significant risk factors of cardiovascular disease?
Signs of hypercholesterolaemia – e.g. xanthelasma, xanthomata, corneal arcus
Signs of peripheral vascular disease – e.g. weak pulses, peripheral cyanosis, cool peripheries, atrophic skin, ulcers, bruits
Describe the pain experienced during an aortic dissection.
Sudden-onset, intense tearing chest pain
Radiating to the back (between the shoulder blades)
List some clinical signs that are associated with aortic dissection.
Different blood pressures in the two arms
Aortic regurgitation
Pleural effusion (due to irritation of pleura)
Describe the typical presentation of pneumothorax.
Sudden-onset pleuritic chest pain with breathlessness
Describe the typical presentation of PE.
Sudden-onset pleuritic chest pain with breathlessness
With or without haemoptysis
Patients may also have a swollen/inflamed leg (DVT)
What is the most common finding on examination of patients with PE?
Tachycardia
Describe the typical presentation of Boerhaave’s perforation.
Sudden-onset severe chest pain immediately after an episode of vomiting
What is the most important investigation to perform in a patient with chest pain?
ECG
Other than tachycardia, which other ECG sign is associated with PE?
S1Q3T3
What are the two main ECG signs associated with myocardial infarction?
ST elevation
New-onset LBBB
How long is the delay between myocardial damage and a rise in troponins?
3 hours
Describe how CK-MB is different to troponins.
They rise more rapidly following damage to the myocardium but it is less specific for cardiac damage
Returns to normal after 2-3 days