Differentials for Chest Pain

Question 1

Describe Symptoms that would favour (Acute Coronary Syndrome)

Answer 1

1. Onset at Rest
2. Severe Pain
   3.Sweating
   4.Anxiety
   5.No relief with nitrates
3. Nausea and Vomitting

Question 2

Describe Symptoms that favour Myocardial Infarction

Answer 2

1. Central Chest Pain
2. Subacute Onset (minutes)
3. Severe Pain

CENTRAL PAIN

Question 3

Describe Symptoms that favour Angina

Answer 3

1. Onset with Exertion
2. Moderate pain or discomfort
3. No Sweating
4. Mild or no anxiety
5. Rapid relief with nitrates
   6.

Question 4

Describe symptoms that favour Aortic Dissection

Answer 4

1. Pain radiates to the back
2. Instantaneous Onset
3. Very severe pain, tearing Quality,

Question 5

Describe symptoms that would favour Myocardial Ischaemia

Answer 5

1.Exertional
2.Brief episodes
3.Diffuse
4.No chest wall tenderness

Question 6

Describe symptobs that favour Chest Wall Pain.

Answer 6

1. Positional
2. Often Worse at rest
3. Prolonged
4. Localised
5. Chest Wall Tenderness.

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Question 7

Orthopnoea and PND

Describe condtions which would present with Orthopnoea/PND that lasts for Seconds/Minutes, Hours/Days, Weeks or More

Answer 7

Seconds/Minutes
1. Asthma
2. Pulmondary Embolism
3. Pulmonary Oedema
4. Foreign Body
5. Trauma/Pneumothorax
6. Anxiety/ Hysteria

Hours/Days
1. Infective(Pneumonia)
2. COPD/Asthma
3. Cardiac Failure
4. *Acute Pleural Effusion

Weeks/More
1. Pulmonary Fibrosis
2. COPD
3. Interstitial Lung Disease
4. *Pleural Effusion

Question 8

Describe causes of Bilateral Pitting Oedema

Answer 8

1. Heart Failure
2. Hepatic-Liver Cirrhosis
3. Renal-Nephrotic Syndrome (body excretes too much protein)
4. GIT- Malabsorption
   (2)(3)(4)cause hypoalbuminaemia
5. Drugs-Calcium Channel Blocker
6. Venous Abnomalities

Question 9

Describe the Casues of Unilateral Oedema

Answer 9

1. DVT
2. Large Vein Compression (tumour/lymph nodes)

Question 10

Describe the Causes of Non-Ptiitng Oedema

Answer 10

1. Hypothyrodism
2. Lymphoedema

Question 11

Describe the Causes and Symptoms of Rheumatic Fever

Rheumatic Fever could lead to Rheumatic Heart Disease

Answer 11

Rheumatic Fever precedes throat infection(2-4 weeks) andis caused by Streptococcus Pyogenes

Symptoms include
1. Migratory Arthritis (pain spreads from one joint to another)
2. Involuntary Movements
3. rash(Erythema Marginatum)

Rhematic HEart Disease-damage to the Heart. Causes Heart Failure, Infective Endocarditis and Atrial Fibrillation.

Question 12

Describe the Symptoms and Risk Factors of Infective Endocarditis

Answer 12

Typically Bacterial
Symptoms
1. Fever, Night sweats
2. Malaise and Fatigue
3. Weight loss
TB-like symptoms

RISK Factors
1. Dental Procedures
2. Immune suppression: Diabetes mellitus, Alcohol abuse, HIV/AIDS
3. Haemodialysis
4. Previous Episode of Infective Endocarditis
5. Valvular Heart Disease
6. Intravenous Drug Use.