Common chest histories - Chest pain

Question 1

What would you want to ask about chest pain?

Answer 1

SOCRATES

Question 2

What would you want to ask about on systemic enquiry in someone with chest pain?

Answer 2

• General - fever, sweats
• Cardiorespiratory - SOB, palpitations, cough, wheeze, haemoptysis/sputum, leg swelling

Question 3

What symptoms in assocaition with chest pain would make you think someone was having an MI?

Answer 3

• Crushing central chest pain
• Radiates to neck/left arm
• Assocaited nausea
• SOB
• Sweatiness
• CVS risk factors

Question 4

What features assocaited with chest pain may suggest angina as the cause?

Answer 4

• CArdiac type pain
• Assocaited with exertion
• Relieved by rest

Question 5

What features associated with chest pain may suggest aortic dissection as a cause of chest pain?

Answer 5

• Radiating to back/between shoulder blades
• Tearing nature - very sudden onset
• Pain in other sites - arms, lecks, neck, shoulder

Question 6

What features of chest pain would suggest pericarditis as the cause?

Answer 6

• Retrosternal/precordial pleuritic chest pain
• Relieved by sitting forward
• Can radiate to trapezius ridge/neck/shoulder

Question 7

What features assocaited with chest pain may suggest a PE as a cause?

Answer 7

• Pleuritic type pain - sudden onset
• SOB +/- haemoptyisis
• Risk factors - surgery, immobility, long haul flight, malignancy

Question 8

What features associated with chest pain would suggest pneumothorax as the cause?

Answer 8

• Sudden onset pleuritic chest pain
• SOB if large
• Risk factors - tall/thin, marfans, COPD/asthma

Question 9

What features of chest pain would suggest Oesophageal spasm as the cause?

Answer 9

Retrosternal chest pain - can be after eating

Question 10

What features associated with chest pain would suggest GORD as the cause?

Answer 10

• Retrosternal burning chest pain
• Related to meals, lying, straining
• Waterbrash

Question 11

What features assocaited with chest pain would indicate antiety/panic attack as a cause?

Answer 11

• Tight chest pain
• SOB
• Sweating
• Dizziness
• Palpitations
• Feeling of impending doom
• Anxious personality
• Recurrent episodes triggered by stimulus

Question 12

What features of chest pain would suggest a musculoskeletal cause?

Answer 12

• Sharp chest pain
• Exacerbated by movement
• Can point to where its worst
• Exacerbated by pressure over area

Question 13

What are causes of chest pain?

Answer 13

• MI
• Aortic Dissection
• Angina
• Pericarditis
• PE
• Pneumothorax
• GORD
• Anxiety/panic attack
• MSK
• Costochondiritis
• Tietze syndrome
• Gastritis
• Myocarditis