Lecture 19: Chest pain Flashcards
What makes pain cardiac?
Front of the chest, mid or upper sternum (‘central’)
Radiating to left arm, both arms, round the chest or into the jaw
Described as tight, heavy, constricting, crushing, numbing or burning
What might be the symptoms of a silent MI?
Nausea, abdominal pain, tachycardia
What is pericarditis like?
Mediastinal (central) pain, referred to shoulder & back
Often sharp in nature, but can be dull
Made worse by breathing, coughing, sneezing
Influenced by posture, typically relieved by sitting forward
What causes pericarditis?
Can happen after an MI (Dressler’s)
Viral infection
- in context of ‘flu like illness
- Coxsackie virus, mumps, herpes, HIV
What is reflux disease like?
Pain can be burning, crushing, sharp, continuous, wave-like, or acute
Can mimik cardiac
pain
Relieved by more alkaline substances (e.g. milk) and antacids
Worse after eating, on bending forward/lying flat - raising head of bed and smoking cession
What are the oesophageal causes of chest pain?
GORD, oesophagitis, oesophageal spasm, oesophageal rupture
What are the lung causes of chest pain?
Infection (pneumonia = radiological diagnosis = LRTI with CXR changes)
Can get effusion, empyaema or pleurisy as complication
Carcionma
Pneumothorax
Trauma
Thrombus (PE)
Immunological causes (e.g. vasculitic)
What is pleuritic pain?
Severe ‘sharp’, ‘stabbing’ or ‘knife-like’
Usually one sided
Worse on inspiration
Mode of onset & associated symptoms gives clue to aetiology
What are the risk factors for PE?
Immobility, pregnancy, oestrogen therapy, obesity
What are the PE rule out criteria (PERC)?
Age >50 HR>100 SaO2<95% in air Unilateral leg swelling Haemoptysis Recent surgery/trauma Prior DVT/PE Hormone use
What are the vascular causes of chest pain?
Aortic dissection
PE
Aortitis
How does aortic dissection pain differ from MI?
More sudden onset
Described as ‘tearing’
Moves from front to back as the dissection extends
What are the musculoskeletal causes of chest pain?
Induced or relieved by postural change
Highly localised
Reproduced by pressure
Tietze’s Syndrome
What is Tietze’s Syndrome?
Specific type of costochondritis
M>F, 20-30 years old
Pain localised to costal cartilage, usually palpable (tender) nodularities
Exacerbated by coughing, sneezing, motion
Usually post-viral URTI
What are the neurological causes of chest pain?
Herpes zoster (‘shingles’), which is usually accompanied by a blistering rash along a dermatomal distribution – classically not passing the midline
Nerve roots can become compressed or irritated by: vertebral body collapse
(secondary to trauma or metastases), metastatic growth and invasion,
infection (including discitis)
