chest pain Flashcards
what does chest pain commonly result in
very common but scary for pts, challenging and frightening for docs. Very likely to lead to primary care appointment, more than other symptoms
Patients worry about death, pain and when it’ll end
Some causes are fatal, serious consequences, diagnostic uncertainty
what are sources of chest pain
Any structure in the chest can cause pain (cardiac, pericardial, oesophageal, pleural, vascular, musculoskeletal, neural) superficial structures (skin, breast, ribs), deep structures (oesophagus, respiratory tract, lungs/pleura, heart, aorta, spine) or referred pain (face, liver, arms, neck)
what are life threatening causes of chest pain
Heart – myocardial ischaemia, myocarditis/pericarditis
Lungs – pneumothorax, PE
Oesophagus – rupture
Aorta – dissection
what are non life threatening causes of chest pain
Heart – heartburn, GORD, palpitations
Musculoskeletal – costochondritis, tietze’s
Trauma – non penetrating
what is chest pain often described as
Front of the chest, mid or upper sternum (‘central’), Radiating to left arm, both arms, round the chest or into the jaw, Described as tight, heavy, constricting, crushing, numbing or burning
impending doom
what can ACS result in
a spectrum, STEMI, NSTEMI and unstable angina – less predictable with less exacerbating/relieving factors, angina (predictable, relieved by rest and nitrates), MI (permanent ischaemic damage, can be see with STEMI though often only detected in traces)
ECG
how can pericarditis result in chest pain
Mediastinal (central) pain, referred to shoulder and back
Often sharp but can be dull
Worse by breathing coughing sneezing
Influenced by posture, typically relieved by sitting forwards
Caused by MI or viral infection
how can the oesophagus cause chest pain
Reflux disease – GORD, oesophagitis, spasm
Burning, crushing, sharp, continuous or wave like (mimic cardiac pain)
Relieved by alkaline substances, worse after eating, chronic but not sinister
how can the lungs cause chest pain
LRTI – pleura sensitive to pain - effusion, empyema, pleurisy
Infection like pneumonia could also be carcinoma, pneumothorax, trauma, thrombus (PE) and immunological
how can pleuritic pain cause chest pain
Severe and stabbing
One sided
Worse on inspiration
PE (thrombus from DVT, RF like immobility, pregnancy, oestrogen therapy, obesity)
Dyspnoea commonest symptom, massive PE causes central chest pain
Pleuritic pain and haemoptysis with infarction
how can vascular issues cause chest pain
Aortic dissection
Hard to diagnose but can be repaired surgically
Different to MI, more sudden onset, tearing, front to back as it extends, more common in men
how can musculoskeletal issues cause chest pain
Induced or relieved by postural change
Highly localised
Reproduced by pressure
Tietze’s syndrome (specific type of costochondritis)
how can neurological issues cause chest pain
Neuralgia and neuropathy – eg Herpes Zoster or Nerve roots compressed or irritated
what are other causes of chest pain
Mastitis (pain localised to structures of the breast)
Mastalgia (hormonally mediated breast pain)
Gynaecomastia
Cysts (usually benign)
Chest pain can be due to anxiety / underlying psychological factors,
usually accompanied by headache, dizziness, low back pain, hyperventilation, fatigue (TATT), dysmenorrhoea, aggression
how can chest pain be investigated
SOCRATES
chest pain history
Examination – inspection, auscultation, palpitation, BP, HR, RR, SaO2
Investigation – bloods, xray, ECG
