Differentials

Question 1

Causes of chest pain

Answer 1

Main - CAD
Other:
- Aortic stenosis
- ACS
- Angina
- MV prolapse
- Hypertrophic cardiomyopathy (HOCM)
- Tachyarrythmias
- Anaemia
- Thyrotoxicosis
- Aortic dissection
- Pericardititis

Question 2

Upper GI causes of chest pain

Answer 2

• GORD
• Gallstones
• Peptic ulcers
• Pancreatitis
• Gastritis
• Cholecystitis

Question 3

Respiratory causes of chest pain

Answer 3

• PE
• Pneumothorax
• Pneumonia
• Pleurisy
• Pulmonary HTN

Question 4

Musculoskeletal causes

Answer 4

• Costochondritis
• Herpes Zoster (shingles)

Question 5

Aortic dissection pain

Answer 5

Severe ripping pain, intrascapular/back

Question 6

What is angina (pectoris)?

Answer 6

Discomfort in chest and/or adjacent areas (jaw, shoulder, back, arm) caused by myocardial ischaemia. Most commonly due to CAD.

Question 7

What is typical angina?

Answer 7

It has these 3 characteristics:

1. Constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
2. Precipitated by physical exertion
3. Relieved by rest or GTN within about 5 mins

Question 8

What is atypical angina?

Answer 8

Chest discomfort which meets 2 of the typical angina characteristics.

Question 9

Risk factors for CAD

Answer 9

• Age
• Gender
• Diabetes
• Hyperlipidaemia
• Smoking
• Hypertension

Question 10

What parts of the history are useful for diagnosing CAD?

Answer 10

1. Con-current diagnosis of CAD (e.g. stable angina, previous MI)
2. Con-current diagnosis of other athersclerotic arterial disease (e.g. ischaemic stroke, peripheral vascular disease, renovascular disease)
3. FH of CAD or atherosclerotic arterial disease

Question 11

Presentation of CAD

Answer 11

• Silent ischaemia (no chest pain)
• Stable/unstable angina pectoris
• NSTEMI
• STEMI
• Heart failure
• Sudden death

Question 12

ACS Presentation

Answer 12

• Chest pain (>20 min) at rest
• New onset/worsening of existing angina
• Angina following MI
• Atypical presentations are common in >75 yrs

Question 13

Differentials of ACS

Answer 13

• PE
• Aortic dissection
• Pericarditis
• Valvular heart disease
• Pneumothorax
• Pneumonia
• Pleural effusion
• Anaemia
• Paroxysmal arrhythmia

Question 14

Risk factors of CVD

Answer 14

• Smoking
• Poor diet
• High blood cholesterol
• High BP
• Insufficient exercise
• Overweight/obese
• Diabetes
• Psychosocial stress
• Excess alcohol consumption

Question 15

What is Ventricular Tachycardia?

Answer 15

• 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)

Question 16

Describe Atrial Fibrillation

Answer 16

• Irregularly irregular
• Different distances between R-R waves
• No distinct P waves

Question 17

Acute MI Post operatively

Answer 17

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.