Chest Pain

Question 1

Differentials of chest pain

Answer 1

CARDIAC
Angina: stable/unstable 
ACS/MI
Pericarditis 
Aortic Dissection
Heart Failure
cardiomyopathy
AF
Endocarditis 
aortic stenosis 

RESP -
asthma
COPD
PE 
Pleural Effusion
Pneumothorax 
Infection 
GI -
gord 
Other - anxiety

Question 2

System specific Qs

Answer 2

SOCRATES for pain 
palpitations 
syncope
SOB 
Oedema 
INtermittent claudication 
Systemic symptoms - fatigue, fever, weight loss/gain

Question 3

How does angina present

Answer 3

Stable - Pain on exertion (may feel like gas or indigestion)
only lasts 5 mins and relieved by rest/medication
Unstable - chest pain (may be shoulder, arm, jaw, neck, back) that comes on at rest or exertion
discomfort may feel like tightness, squeezing, crushing, burning, choking, aching
SOB
Sweating
doesnt easily resolve

Question 4

Investigations for Angina

Answer 4

ECG
Bloods - FBC, cardiac markers e.g. troponin, (NOTE: in unstable angina this wont be raised, but it will be in an MI)
CT Angiogram

Question 5

Management of Angina

Answer 5

Lifestyle advice - stop drinking/smoking/exercise more/better appetite
Medications:
Anti anginal - CCB or BB
GTN spray (dilitation of heart vessels)
Aspirin and statin
blood pressure management - ACE inhibitor/ARB
Unstable - Stent, CABG

Question 6

Presentation of MI

Answer 6

Crushing chest pain radiating to arm/jaw/neck/back
Sweating
Sense of impending doom

Question 7

Investigations for MI

Answer 7

ECG
Bloods - FBC, troponin, BNP and ANP
Scan - Angiography

Question 8

Management of MI

Answer 8

A-E
MONA
surgery - CABG/stent
clopidogrel for life

Question 9

Complications of an MI

Answer 9

Acute: conduction abnormalities, rupture of muscle/valve, tamponade, cardiogenic shock
more likely for future MI,heart failure

Question 10

How does pericarditis present

Answer 10

pleuritic, retrosternal pain

relieved by sitting forawrd, POST VIRAL