chest pain Flashcards
1
Q
briefly describe chest pain in a clinical setting? 4
A
- Common 1-3% of GP consultations, lots of things can cause it
- Scary for patients am I going to die? What is this? Painful? When will it end?
- Some causes are fatal, serious consequences
- There are a lot of overlaps and similarities
2
Q
describe the superficial structures that can cause chest pain? 3
A
- Skin
- Breast tissue
- Ribs
3
Q
describe the deep structures that can cause chest pain? 6
A
- Oesophagus
- Respiratory tract
- Lungs/ pleura
- Heart
- Aorta
- Spine
4
Q
where can chest pain be referred to? 4
A
- Face
- Liver
- Arms
- Neck
5
Q
name some life threatening causes of chest pain? 6
A
Heart:
- Myocardial ischaemia
- Myocarditis/ pericarditis
- Ruptured aortic aneurysm
Lungs: - Pneumothorax
- PE
Oesophagus:
- Rupture
6
Q
how do you take a history for chest pain? 6
A
- Site of pain
- Quality and intensity of pain
- Pattern and duration
- Exacerbating factors
- Associated symptoms
- Relieving factors
7
Q
what makes chest pain cardiac in nature? 3
A
- Front of the chest, mis or upper sternum
- Radiating to left arm, both arms, round the chest or into the jaw
- Described as tight, heavy, constricting, numbing or burning
8
Q
describe MI vs angina vs ACS? 6
A
- MI- can occur with classical ECG changes STEMI, more commonly occur with other patterns of changes, only detected by comparing serial traces. Permanent cardiac myocyte damage occurs
- ACS: refers to STEMI, NSTEMi and angina
- Unstable angina is less predictable and less closely related to exacerbating factors and reliving factors
- ECG can change with all, and be normal in all
- Is the pain predictable?
- Is it relived with rest or nitrates?
9
Q
describe chest pain with pericarditis? 6
A
- Mediastinal pain, referred to shoulder and back
- Sharp in nature but can be dull
- Made worse by breathing, coughing, sneezing
- Influenced by posture, relived by sitting forward
- Can happen after an MI
- Viral infection can cause it
10
Q
describe chest pain related to the oesophagus? 5
A
- Reflux disease, GORD, oesophagitis, oesophageal spasm
- Pain can be burning, crushing, sharp, continuous can mimic cardiac pain
- Relieved by alkaline substances and antacids
- Worse after eating
- Chronic but often no serious
11
Q
describe pleuritic pain? 6
A
- Sharp, stabbing
- One sided
- Worse on inspiration
- PE?
- Venous thrombi?
- Occurs with infarction
12
Q
name some vascular considerations for chest pain? 5
A
- Aortic dissection
- More sudden onset
- Described as tearing pain
- Moves from front to back as the dissection extends
- More common in men
13
Q
describe some neurological causes for chest pain? 2
A
- Herpes zoster blistering rash along dermatomal distribution
- Nerve roots become compressed or irritated by vertebral body collapse, metastatic growth, infection
14
Q
what other causes are there to consider for chest pain? 5
A
- Mastitis
- Mastalgia
- Gynaecomastia
- Cysts
- Chest pain related to anxiety
15
Q
how do we examine patients with chest pain? 7
A
- Inspection
- Auscultation
- Palpation
- BP
- HR
- RR
- SaO2
