Differential Diagnosis- Acute Chest Pain - Other Causes Flashcards
Musculoskeletal - Classical History?
- Sharp chest pain
- Worse by movement and inspiration
- Can point to where worse
- Worse by pressure over area
Musculoskeletal - Classical Examination Findings?
- Tenderness over area of pain
- Normal exam otherwise
Musculoskeletal - Investigations?
Diagnosis of Exclusion:
- D Dimer - exclude PE
- CXR - exclude pneumathorax or infection
- Inflammatory markers - normal
Musculoskeletal - Treatment?
- Analgesia
- Deep breathing to prevent infection
Costochondritis - Classical History?
- focal chest wall pain,
- may have known precipitating injury;
- aggravated by sneezing, coughing,
- deep inspiration,
- twisting of the chest
Costochondritis - Classic Examination Findings?
- reproducible pain, especially at the costochondral junctions
- Normal exam otherwise
Costochondritis - Investigations?
Diagnosis of Exclusion:
- ECG/Troponin - exclude MI
- CXR - normal
Costochondritis - Treatment?
- NSAIDS
- Physical therapy
GORD - Classical History
- retrosternal burning with eating large or fatty meals
- that can be reproduced with lying supine and relieved by sitting up;
- relieved by antacids
GORD - Classical Examination Findings?
- no specific physical findings
- maybe tenderness over area if associated gastritis
GORD - Investigations?
- therapeutic trial: relief of symptoms with short trial of proton-pump inhibitors
- Oesophagogastroduodenoscopy:oesophageal inflammation or erosions
- oesophageal pH monitoring:persistently low pH (<4) may indicate reflux disease
GORD - Treatment?
- Lifestyle advice
- Antacids
- Triple therapy
Anxiety or Panic Attack - Classical History?
- sharp chest pain with anxiety,
- dizziness or faintness,
- palpitations, sweating, trembling or shaking,
- fear of dying or going insane, paraesthesiae,
- chills or hot flushes, breathlessness or choking sensation
Anxiety or Panic Attack - Classic Examination Findings?
- hyperventilation,
- examination otherwise normal
Anxiety or Panic Attack - Investigations?
- ECG: normal
- CXR: normal
- HADS (hospital anxiety and depression scale) score: score >11
Anxiety or Panic Attack - Treatment?
- Reassurance
- CBT
Oesophageal Spasm - Classical History?
- crushing substernal chest pain,
- associated dysphagia,
- pain does not always correlate with swallowing,
- dysphagia precipitated by very hot or cold foods,
- glyceryl trinitrate can relieve the pain
Oesophageal Spasm - Classic Examination Findings?
- Normal
Oesophageal Spasm - Investigations?
- barium swallow: corkscrew or rosary bead appearance on barium swallow
- oesophageal manometry:simultaneous contractions on >30% of wet swallows
Oesophageal Spasm - Treatment?
- Avoid ppting foods
- Try PPi
- Nitrates
- Ca blockers
- Phosphodiesterase inhibitors
- Antidepressants
Other Differentials?
- Gastritis
- Peptic ulcers
- Acute cholecystitis
- Pancreatitis
- Fibro
- Tietze syndrome
