Differentials Flashcards
Causes of chest pain
Main - CAD Other: - Aortic stenosis - ACS - Angina - MV prolapse - Hypertrophic cardiomyopathy (HOCM) - Tachyarrythmias - Anaemia - Thyrotoxicosis - Aortic dissection - Pericardititis
Upper GI causes of chest pain
- GORD
- Gallstones
- Peptic ulcers
- Pancreatitis
- Gastritis
- Cholecystitis
Respiratory causes of chest pain
- PE
- Pneumothorax
- Pneumonia
- Pleurisy
- Pulmonary HTN
Musculoskeletal causes
- Costochondritis
- Herpes Zoster (shingles)
Aortic dissection pain
Severe ripping pain, intrascapular/back
What is angina (pectoris)?
Discomfort in chest and/or adjacent areas (jaw, shoulder, back, arm) caused by myocardial ischaemia. Most commonly due to CAD.
What is typical angina?
It has these 3 characteristics:
- Constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
- Precipitated by physical exertion
- Relieved by rest or GTN within about 5 mins
What is atypical angina?
Chest discomfort which meets 2 of the typical angina characteristics.
Risk factors for CAD
- Age
- Gender
- Diabetes
- Hyperlipidaemia
- Smoking
- Hypertension
What parts of the history are useful for diagnosing CAD?
- Con-current diagnosis of CAD (e.g. stable angina, previous MI)
- Con-current diagnosis of other athersclerotic arterial disease (e.g. ischaemic stroke, peripheral vascular disease, renovascular disease)
- FH of CAD or atherosclerotic arterial disease
Presentation of CAD
- Silent ischaemia (no chest pain)
- Stable/unstable angina pectoris
- NSTEMI
- STEMI
- Heart failure
- Sudden death
ACS Presentation
- Chest pain (>20 min) at rest
- New onset/worsening of existing angina
- Angina following MI
- Atypical presentations are common in >75 yrs
Differentials of ACS
- PE
- Aortic dissection
- Pericarditis
- Valvular heart disease
- Pneumothorax
- Pneumonia
- Pleural effusion
- Anaemia
- Paroxysmal arrhythmia
Risk factors of CVD
- Smoking
- Poor diet
- High blood cholesterol
- High BP
- Insufficient exercise
- Overweight/obese
- Diabetes
- Psychosocial stress
- Excess alcohol consumption
What is Ventricular Tachycardia?
- 250 bpm
- No pulse
- Caused by hormones, low oxygen, stretch or scarring of cells (reentrant V tach)
- SOB
- Chest pain
- Palpitations
- Light-headed/dizzy
- Faint
- Wide QRS complexes (>3 small squares)
Describe Atrial Fibrillation
- Irregularly irregular
- Different distances between R-R waves
- No distinct P waves
Acute MI Post operatively
ACS occur commonly after surgery, NSTEMI most common followed by unstable angina and STEMI.
Occur in first 3 days post-op, to reduce risk see patients in pre-op clinics to assess risk.
