differential diagnosis of chest pain

Question 1

Pleurisy

Answer 1

Causes: Pleural infection, inflammation, trauma or malignancy
Location: Unilateral and often localised
Onset: Rapid
Characteristic: Sharp, stabbing
Aggs: Deep breaths and coughing
Associated symptoms: Pleural rub, crackles, dyspnoea

Question 2

Pulmonary Embolus

Answer 2

Causes: DVT
Location: often lateral, on the side of the embolism but may be central
Onset: Sudden
Characteristic: sharp
Associated symptoms: dyspnoea, tachypnoea, tachycardia, hypertension, hypoxaemia, painful swollen lower leg

Question 3

Pneumothorax

Answer 3

Causes: Trauma, lung disease, spontaneous
Location: Could be anywhere, depends how its caused
Characteristic: Sharp
Severity: Depends on mediastinal shift
Associated Symptoms: dyspnoea, decreased/absent sounds on the side of the pneumothorax, hyperresonant percussion, hypoxaemia

Question 4

Tracheitis (inflammation of the trachea)

Answer 4

Causes: Bacterial infections, irritants
Location: Central
Characteristic: Burning
Intensity: Constant
Aggs: breathing

Question 5

Rib Fracture

Answer 5

Causes: Trauma, tumour, fractures from osteoporosis or lung disease, surgery
Location: localised point tenderness
Onset: Often sudden
Aggs: Inspiration

Question 6

Muscular

Answer 6

Causes: Trauma, unaccustomed exercise, excessive coughing, excessive coughing from lung disease
Location: Superficial
Aggs: inspiration and some body movements

Question 7

Costochondritis & Tietze syndrome

Answer 7

Causes: Trauma, viral infection
Location: Localised to one or more costochondral joints
Characteristic: nonspecific chest pain
Aggs: sneezing, coughing, deep inspiration, twisting of the chest, reproducible pain at the costochondral junctions
Eases: anti inflammatory and ice or heat

Question 8

Acute coronary syndrome (angina/heart attack)

Answer 8

Causes: ischemic heart disease
Location: central, retrosternal with or without pain radiation to the jaw or upper left extremities
Onset: Pain at rest is more typical of infarction, and pain on high stress is normally typical of angina
Characteristic: pressure, tightness, squeezing, heaviness, burning
Aggs: exertion, psychological stress lasting less than 10 mins (angina) MI lasts more than 30 minutes generally
Eases: angina is eased by nitro-glycerine
Associated Symptoms: nausea, vomiting,, dyspnoea, dizziness, hypotension, arrhythmias

Question 9

Neuralgia (sharp severe pain along the path of a nerve)
- causes, location, characteristic, eases

Answer 9

Causes: Thoracic spine dysfunction, tumour, trauma, shingles
Location: Dermatomal distribution
Quality: Sharp or burning or paraesthesia
Eases: antivirals if caused by shingles

Question 10

Pericarditis (inflammation of the heart pericardium)
- causes, location, characteristic, eases,, associated symptoms

Answer 10

Causes: infection, inflammation, trauma, tumour
Location: retrosternal, towards cardiac apex, may radiate to left shoulder
Quality: sharp
Eases: sitting up and leaning forward
Associated symptoms: tachycardia, pericardial friction rub

Question 11

Mediastinal Shift
- causes, location, onset, characteristic,

Answer 11

Causes: pneumothorax, rapid drainage of a large pleural effusion
Location: poorly localised, central discomfort
Onset: sudden
Characteristic: severe