Differential Diagnosis - Acute Chest Pain - Cardiac

Question 1

Cardiac?

Answer 1

1. ACS
2. Aortic Dissection
3. Pericarditis
4. Myocarditis
5. Other Cardiac differerentials

Question 2

ACS?

Answer 2

Classical History

• Crushing Chest Pain
• Radiates to neck/left arm
• Associated nausea/SOB/sweatiness
• Cardivascularrisk factors

Question 3

Classical examination findings for ACS?

Answer 3

• May be normal
• Sweaty, SOB, Pain
• CVS: S4 gallop, JVP dissetension, signs of heart failure
• Brady/Tachy

Question 4

Investigations findings for ACS

Answer 4

• ECG: ST elevation (or new LBBB), inverted T waves, Q waves
• Increased Trops, but normal in unstable angina
• CXR: normal or signs of heart failure
• Coronary angiography

Question 5

Treatment/Management of ACS

Answer 5

• ABCDE
• MONAC: Morphine, oxygen, nitrates, aspirin, clopidogrel
• Primary coronary intervention

Question 6

Aortic Dissection - Classical History?

Answer 6

• Tearing chest pain of very sudden onset
• Radiates to the back
• Pain in other sites, head, neck, arms

Question 7

Aortic Dissection - Classical Findings?

Answer 7

• Unequal arm pulses or BPs
• Maybe acute aortic regurgitation
• New neuro symptoms due to carotid/vertebral artery symptoms

Question 8

Aortic dissection - Investigation findings?

Answer 8

• CXR: Widened mediastinum
• CT angio or transoesophageal echo
• ECG: signs of MI

Question 9

Aortic Dissection - Treatment?

Answer 9

• Type A - surgical repair
• Type B - BP control

Question 10

Pericarditis - Classical History

Answer 10

• Retrosternal/precordial pleuritic chest pain
• Relieved by sitting forward
• Radiates to the traps, neck, shoulders
• Viral prodrome common

Question 11

Pericarditis - Classical Examination findings?

Answer 11

• Pericardial rub
• Tachy
• JVP disstension and pulsus paradoxus could indicate tamponade

Question 12

Pericarditis - Investigation findings?

Answer 12

• ECG: PR depression, saddle shaped ST elevation
• CXR: Maybe globular heart if effusion present
• Echo: If suspect effusion

Question 13

Pericarditis - Treatment?

Answer 13

• NSAIDS
• Treat cause if known

Question 14

Myocarditis - Classical History?

Answer 14

• Chest pain
• Palpitations
• Fever
• Fatigue
• Dyspnoea

Question 15

Myocarditis - Classical Examination Findings?

Answer 15

• ECG: Diffuse T wave inversions, ST elevation/Depression
• Inflammatory markers raised
• Trops raised
• Myocardial biopsy if required

Question 16

Myocarditis - Treatment?

Answer 16

• Supportive
• Bed rest

Question 17

Other Cardiac Differentials?

Answer 17

• Stable angina
• Tamponade
• Mitral valve prolapse
• Pulmonary Hypertension
• Aortic stenosis
• Arrhrythmias